Utilization Management Care CoordinatorSummary:
The Care Coordinator is a non-clinical role responsible for supporting the case management team by performing various administrative tasks that do not require clinical evaluation or interpretation. The Care Coordinator works under the supervision of a licensed healthcare professional and plays a critical role in maintaining the accuracy and completeness of case data and supporting the overall efficiency of the department. This is a contract that concludes at the end of 2024 with no extension.
Location: Must reside within the Pacific Time Zone or the Mountain Time Zone
Essential Functions:
- Data Entry and Case Creation: Assist in the data entry of Case/Care Manager notes and case creations for various types of admissions, including Behavioral Health, Maternity, Prior Authorizations, NICU, and Maternity.
- Outbound Communications: Make outbound phone calls to beneficiaries and providers as necessary.
- Electronic Fax Processing: Work with electronic faxes by identifying the type of admission, verifying region and eligibility, facility location, and sending to the appropriate ‘Work Que’.
- Data Integrity Maintenance: Ensure the integrity of the data by entering information into the department’s data systems completely and accurately.
- Data Analysis and Research: Assist with data analysis and research of authorizations, patient eligibility searches in DEERS, or registrations.
- Claims Resolution: Assist with the resolution of claims pended by the claims department.
- Liaison Role: Act as a liaison between various functional areas.
- Provider Data Collection: Contact provider offices to gather data as needed.
- Non-Clinical Processes and Projects: Assist with non-clinical CM processes and special projects as directed by CM managers.
Duties:
- Complete all Centene, HNFS, and CM Department training specific to the role upon new hire and ongoing on a yearly basis.
- Assist in the data entry of Case/Care Manager notes and case creations.
- Make outbound phone calls to beneficiaries and providers.
- Work electronic faxes and process the information correctly.
- Maintain data integrity by accurately entering information into data systems.
- Assist with data analysis and research of authorizations and eligibility.
- Help resolve claims issues as needed.
- Act as a liaison between different departments.
- Contact provider offices to collect necessary data.
- Support non-clinical processes and special projects as directed.
Qualifications:
Education: High School Diploma or equivalent.
Location: Must reside within the Pacific Time Zone or the Mountain Time Zone
Experience: Previous experience in a healthcare or administrative role is preferred.
Knowledge, Skills, and Abilities: - Proficiency in data entry and maintaining data integrity.
- Strong communication skills, both written and verbal.
- Ability to make outbound calls and communicate effectively with beneficiaries and providers.
- Proficiency in using electronic fax systems and processing information accurately.
- Analytical skills for data analysis and research.
- Problem-solving skills for resolving claims issues.
- Ability to act as a liaison between various functional areas.
- Ability to follow non-clinical processes and assist with special projects.
Training Requirements:
- Completion of all assigned compliance training(s) including Diversity, Equity, and Inclusion (DEI) and Health Equity trainings.
- Completion of attestation that the CMA Care Coordinator work instructions have been reviewed to ensure knowledge of allowable scope of practice and process for clinical escalation.
- Demonstrate competency with CMA Care Coordinator processes specific to the role as evidenced by 1:1 monitoring and passing audit scores.
Location: Must reside within the Pacific Time Zone or the Mountain Time Zone
There is a very extensive background screening that will need to be discussed upon progress.
Schedule:
2 Part Time 8am-4:30pm Pacific Time M-T
*During the training period, the schedule is M-F 7:30a-4pm Pacific Time*
Job Types: Part-time, Contract
Pay: From $20.00 per hour
Expected hours: 20 per week
Benefits:
Schedule:
Experience:
- Coordination of Care: 2 years (Required)
- Utilization Management: 1 year (Required)
Work Location: Remote
