Managed Care Coordinator

Contract Duration: 3+ Months (possible extension based on performance) Work Location: Newark, NJ 07105 Pay Rate: $20.00 - $21.43/hr on w2 Position Overview This position supports the Health Services and Utilization Management (UM) functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members, and Member Service Coordinators. Key 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. Prepare, document, and route cases in the appropriate system for clinical review. Initiates call backs and correspondence to members and providers to coordinate and clarify benefits. Upon completion of inquiries, initiates call backs or correspondence to Physicians/Members to coordinate and clarify case completion. Reviews professional medical/claim policy-related issues or claims in pending status. Upon collection of clinical and non-clinical information, MCC can authorize services based upon scripts or algorithms used for pre-review screening. Note: Non-clinical staff members are not responsible for conducting any Utilization Management (UM) review activities that require interpretation of clinical information. Perform other relevant tasks as assigned by Management. The following personal and professional attributes are critical for successful performance: Customer Focus Accountability Learning Agility Communication Skills Qualifications Education High School Diploma (Required) Some College Education (Preferred) Work Experience 1–2 years of customer service experience or experience in a medical support-related position (Preferred) Specialized Knowledge & Skills Required Knowledge of medical terminology Good oral and written communication skills Ability to make sound decisions under the direction of a Supervisor #J-18808-Ljbffr eTeam