Care Management Coordinator

Come lead with us at New York, NY The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Insure high quality, cost-effective care and services for Elderplan members through support of professional Care Management and/or Clinical Service activities. The position supports all aspects of care coordination for our Medicare, Medicaid, and/or dual product members in compliance with all departmental and regulatory requirements. Processes all newly enrolled cases according to established EP/HF Coordinated Care team workflows and maintains integrity of members’ files Receives and processes requests and inquiries through interdepartmental communication system regarding covered/ non covered services/supplies Receives and processes initial requests and inquiries regarding pre-authorization of services/supplies. Coordinates and provides service authorizations to vendors Accurate and timely data entry support as defined by departmental workflows Participates in scheduled team meetings High School Diploma or equivalent; college degree preferred. One year prior managed care experience required. Prior experience in a health care setting preferred. Familiarity with utilization management/case management. #J-18808-Ljbffr