Managed Care Coordinator

Position: 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.

Core Individual Contributor Competencies

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