Managed Care Coordinator

Managed Care Coordinator I

The Managed Care Coordinator I (MCC I) for the UM Letter Team is a remote-based role responsible for ensuring the quality, accuracy, and compliance of member-facing correspondence. This position plays a critical role in reviewing and validating letters prior to release, supporting regulatory compliance and organizational standards.

This is a fully remote position requiring strong self-management, accountability, and the ability to independently manage workload and priorities in a virtual environment. Demonstrates effective time management skills by balancing production requirements with thorough quality review, ensuring timely completion of assigned tasks without compromising accuracy. Ability to prioritize workload based on case urgency, aging, and operational needs, ensuring high-risk or time-sensitive cases are addressed appropriately.

This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. The MCC I – UM Letter Team role is essential to ensuring that all member communications are accurate, compliant, and professionally delivered. Success in this role requires strong attention to detail, the ability to manage time effectively in a remote environment, and the flexibility to adapt and pivot in response to changing priorities.

Responsibilities:

• 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.
• Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff. Review medical and administrative documentation for accuracy, grammar, and compliance with regulatory standards. Perform initial screening of determination letters, ensuring clarity and compliance before distribution. Make sound, timely decisions under the direction and supervision of a designated Supervisor. Perform other relevant tasks as assigned by Management.

Core Individual Contributor Competencies:

• Customer Focus
• Accountable
• Learn
• Communicate

Qualifications:

Education:

• High School Diploma required. Some College preferred.

Work experience:

• Prefer 3-5 years customer service or medical support related position.

Specialized knowledge/skills:

• Requires knowledge of medical terminology
• 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 Requires knowledge of clinical standards of care, and Star measures.
• Requires operational knowledge of health care delivery systems and health insurance industry.
• Requires appreciation for strategic planning.
• Requires knowledge of NCQA accreditation standards as well as state and federal laws applicable to health plan appeals and grievances.
• Requires knowledge of CMS and state regulatory requirements.
• Requires knowledge of Microsoft 365 and Adobe Pro.