Managed Care Coordinator II

Job not on LinkedIn

🔥 14 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $50.1k - $67.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Care Coordinator

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Support Clinical Operations functions and act as a liaison between members, physicians, delegates, and member service coordinators. • Provide leadership and guidance to non-clinical team and handle escalated issues/problems. • Perform review of service requests for completeness of information. • Collect and transfer non-clinical and structured clinical data from physicians/patients. • Initiate call backs and correspondence to members and providers to coordinate and verify benefits. • Collect and collate information required to handle escalated phone/correspondence inquiries. • Assist with onboarding and training of newly hired Managed Care Coordinators I. • Perform initial screening of precertification requests from physicians/members using established scripts. • Assist members with finding providers, resolving problems and answering questions. • Makes outbound calls to engage members in Case Management and complete necessary health assessments. • Distribute new case assignments to the Case Management Clinical Staff. • Reviews medical, dental and vision claims and address gaps in member's preventative care.

🎯 Requirements

• High School Diploma/GED required • 3-5 years customer service experience • Requires knowledge of medical terminology • Requires Good Oral and Written Communication skills • Requires ability to make sound decisions under the direction of Supervisor • Prefer knowledge of contracts, enrollment, billing & claims coding/processing • Prefer knowledge Managed Care principles • Requires knowledge of clinical standards of care, and Star measures • Requires operational knowledge of health care delivery systems and health insurance industry • Requires appreciation for strategic planning • Requires knowledge of NCQA accreditation standards • Requires knowledge of CMS and state regulatory requirements • Prefer the ability to analyze and resolve problems with minimal supervision • Prefer the ability to use a personal computer and applicable software and systems • Team Player, Strong Analytical, Interpersonal Skills. • May require some travel

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement