Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
The Medical Management Coordinator evaluates patients using targeted intervention business rules and processes to identify needed medical services, makes appropriate referrals to medical services staff, and coordinates the required services by the benefit plan.
Key responsibilities include:
- Communicating health care service delivery as required based on outcomes/reviews noted by the nurse or medical director
- Performing non-medical research pertinent to the establishment, maintenance, and closure of open cases
- Providing support services to team members by answering telephone calls from providers and members, taking accurate messages, and supporting electronic transmission review and referrals as appropriate
- Maintaining accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
- Ensuring communication, both internally and externally, to enhance the effectiveness of medical management services
- Assisting in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow-up as needed
- Completing work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures
- Operating with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.
Requirements:
- Relevant work experience
- Adept at problem-solving and decision-making skills
Preferred Qualifications:
- Telephonic experience
- Member outreach experience
Education:
- High school diploma
Anticipated Weekly Hours:
- 40
Time Type:
- Full-time
Pay Range:
- $18.50 - $35.29
Benefits:
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs, and other resources