Managed Care Coordinator I

Job not on LinkedIn

🔥 0 minutes 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 19%

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

• Support Clinical Operations and act as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. • Review service requests for completeness, collect and transfer non-clinical data, and acquire structured clinical data from physicians/patients. • Prepare, document and route cases in the appropriate system for clinical review. • Initiate callbacks and correspondence to members, physicians and providers to coordinate and clarify benefits and case completion. • Review professional medical/claim policy-related issues or claims in pending status. • Act as liaison with providers, members and Care Managers. • Authorize services based on scripts or algorithms used for pre-review screening under clinical staff oversight. • Handle initial screening for pre-certification requests based on scripts and workflows. • Assist members with finding providers, resolving problems, answering questions, filing appeals and obtaining services. • Make outbound calls to engage members in Case Management and complete health assessments. • Educate members regarding preventive health activities and services. • Assist members with appointments, transportation, PCP and demographic changes, and new ID cards. • Triage and distribute referrals and provider faxes. • Review medical, dental and vision claims and address gaps in members' preventive care. • Perform 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. • 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