Managed Care Coordinator – I

Job not on LinkedIn

🔥 14 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 20%

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.

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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

• 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 and case completion. • 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 under clinical staff oversight. • Handles initial screening for pre-certification requests based on scripts and workflows. • Assists members with finding providers, resolving problems, answering questions, filing appeals, and obtaining services. • 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 members' preventive care. • 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. • Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

🏖️ Benefits

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