Managed Care Coordinator I, Behavioral Health

Job not on LinkedIn

🔥 14 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients. • Prepare, document and route cases in appropriate system for clinical review. • Initiates call backs and correspondence to members and providers to coordinate and clarify benefits. • Reviews professional medical/claim policy related issues or claims in pending status. • Acts as liaison with providers, members and Care Managers. • Authorizes services based upon scripts or algorithms used for pre-review screening when appropriate. • Handles initial screening for pre-certification requests under the oversight of clinical staff. • Assists members with finding providers, resolving problems and answering questions regarding services and appeals. • Makes outbound calls to engage members in Case Management and complete necessary health assessments. • Educates members regarding preventive health activities and services. • Assists members with appointments, transportation, PCP and demographic changes, and new ID cards. • Triages and distributes referrals and provider faxes. • Reviews medical, dental and vision claims and addresses gaps in preventive care. • Reviews medical and administrative documentation for accuracy, grammar, and regulatory compliance. • Performs initial screening of determination letters before distribution. • Makes sound, timely decisions under the direction and supervision of a designated Supervisor. • Performs other relevant tasks as assigned by Management.

🎯 Requirements

• High School Diploma/GED required. • Prefer 1-2 years customer service or medical support related position. • Requires knowledge of medical terminology. • Preferred – Medicaid CM. • 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. • 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.

🏖️ Benefits

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