Managed Care Coordinator II

Job not on LinkedIn

🔥 14 hours ago

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

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

💵 $50.1k - $67.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 17%

What it means: the chance that no one is really hiring for this job.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

• Review service requests for completeness and collect, transfer, and acquire non-clinical and structured clinical data • Prepare, document, and route cases for clinical review • Contact members and providers to coordinate and verify benefits, treatment courses, and case completion • Investigate and resolve escalated phone and correspondence inquiries • Assist with onboarding and training newly hired Managed Care Coordinators I • Act as liaison with providers, members, Care Managers, physicians, delegates, operational business members, and member service coordinators • Authorize services based on scripts or algorithms for pre-review screening under clinical oversight • Perform initial screening of precertification requests using established scripts and workflows • Help members find providers, resolve problems, and understand services and appeals • Engage members in Case Management and complete health assessments • Distribute case assignments to Case Management Clinical Staff • Review medical, dental, and vision claims and address preventive-care gaps • Educate members about preventive health activities and services • Assist with appointments, transportation, PCP and demographic changes, and new ID cards • Triage and distribute referrals and provider faxes • Review and translate English and Spanish medical and administrative documents for designated teams • Work one holiday shift per year for Behavioral Health Clinical Operations

🎯 Requirements

• High School Diploma/GED required • 3-5 years customer service experience • Medical certification translator education required for Letter’s Team and Medically Certified Spanish Translator roles • Knowledge of medical terminology • Good oral and written communication skills • Ability to make sound decisions under the direction of a Supervisor • Knowledge of clinical standards of care and Star measures • Operational knowledge of health care delivery systems and the health insurance industry • Knowledge of NCQA accreditation standards and applicable state and federal laws for health plan appeals and grievances (Letter’s Team and Medically Certified Spanish Translator) • Knowledge of CMS and state regulatory requirements (Letter’s Team and Medically Certified Spanish Translator only) • Team player with strong analytical and interpersonal skills • May require some travel • 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 • Meaningful work that directly improves lives • Mission-driven organization supporting expertise, collaboration, and growth

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