Medical Services Coordination Specialist I

Job not on LinkedIn

🔥 16 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $20 - $27 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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LTHC

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2016

🧘 Wellness

⚽ Sports

👥 B2C

Wellness • Sports • B2C

LTHC é a empresa que detém a Academia LIFT e pretende adquirir ou desenvolver outros espaços no mesmo âmbito. Foca‑se na experiência do cliente — conforto, interação com o espaço e objetivos pessoais — para atletas, praticantes ocasionais e profissionais, apoiando metas de bem‑estar físico, psicológico e desempenho competitivo. Opera como um espaço de fitness/treino com ênfase em culturismo, exercício e saúde.

📋 Description

• Support the workflow of the Medical Services division across Behavioral Health, Quality Management, and Member Care Management programs • Review and prepare clinical cases for clinical staff • Assess member needs using Health Plan-approved case management guidelines and assessment tools • Make referrals to clinical programs and collaborate with clinical care teams to support enrollees • Work with enrollees, caregivers, and legal guardians to identify and achieve shared treatment goals • Manage caseloads and maintain documentation according to Health Plan standards • Advocate for members, address social determinants of health, provide coaching, and place case/disease management referrals • Link enrollees with community resources and ensure referrals result in timely appointments • Monitor member engagement, follow up on outstanding actions, close care gaps, and complete required assessments • Engage members through phone, messaging, and digital tools • Identify members with gaps in care using multiple information sources, HEDIS quality measures, and Value Based Payment Programs • Provide outreach and education on healthcare quality metrics, assess barriers to care, and facilitate access or referrals • Coordinate access to transportation, pharmacy, grocery, food pantry, and other community resources • Prepare and process member and provider correspondence related to disease conditions and care management services • Manage BH/MCM/Quality inboxes and Stored Information Retrieval queues • Adhere to service-level agreements, regulatory commitments, and required timeframes • Ensure care management referrals are accurate and complete through collaboration with internal departments • Request medical records, mail educational materials, answer calls and emails, and perform other non-clinical support duties • Perform intake assessments and triage calls to the appropriate MCM/Quality service area • Provide preliminary support to providers, facilities, and members • Communicate with members and service providers according to regulatory and organizational guidelines • Maintain member privacy, uphold company values, and perform other assigned functions • Level II: Prioritize work, guide junior staff, support training and onboarding, mentor staff, troubleshoot questions, identify barriers, update procedures, and produce care management statistics • Level III: Monitor inventory and workflow, provide reporting and recommendations, update policies and procedures, develop process improvements, handle escalated and complex issues, assess training needs, identify eligibility and coverage, and collaborate on system/process changes

🎯 Requirements

• Minimum of one year experience working in an insurance company, medical assistant or Health Plan customer service, delivering care coordination at a community-based organization or working within a patient facing medical care setting required • Working knowledge of medical terminology • Proficiency with Microsoft Office Suite • Excellent oral and written communication skills • Organizational and interpersonal skills; ability to manage multiple tasks under pressure • Ability to utilize department-specific applications and software, including care management system and department libraries • Ability to utilize engagement strategies such as motivational interviewing • Attention to detail • Level II: Minimum of three years’ experience in an insurance company, community-based care coordination organization, or medical care setting required • Level II: In-depth knowledge of complex rules, care management systems and processes, departmental policies and procedures, product lines, and regulatory requirements • Level II: Ability to recognize sensitive issues and escalate concerns; lead committee activities; support newer team members; exceed productivity standards; identify process improvements; resolve complex issues • Level III: Minimum of five years of experience in an insurance company or medical care setting required • Level III: Thorough knowledge of health plan contracts, regulatory requirements, and unit procedures • Level III: Knowledge of multiple systems and/or processes for identifying and resolving data or process issues • Level III: Ability to precept new staff, handle complex challenges, work independently, participate in meetings and special projects, identify process efficiencies, and develop implementation plans • Level III: Demonstrated presentation skills • Ability to work prolonged periods sitting and/or standing at a workstation and using a computer • Ability to use a keyboard, mouse and/or phone for three or more hours at a time • Ability to travel across the Health Plan service region for meetings and/or trainings as needed • Ability to hear, understand, and speak clearly while using a phone • Regular and reliable attendance is required

🏖️ Benefits

• Group health and/or dental insurance • Retirement plan • Wellness program • Paid time away from work • Paid holidays • Potential remote work on a case-by-case basis • Ability to work in a home office for continuous periods of time for business continuity • Equal Opportunity Employer