Medical Care Coordinator

Shift Time: Days

Remote position

Hours: 8-5

Shift length: 8hrs

Weekend rotation: n/a

On Call: n/a

Scrub Color: N/A

Required Certifications: Required associate's degree with a health care focus or LPN. A Social Work or Register Nurse background.

Job Description:

Job Summary:

A healthcare professional with a customer centric focus to coordinate, outreach to and respond to members regarding issues and questions related to medical conditions, benefits and coverage criteria. 1) Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options. 2) Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc. 3) Act proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. 4.) Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan

Education:

Education Level

Education Details

Required/

Preferred

Associate's Degree

Associate's Degree with a health care focus or LPN

Required

Essential Functions:

Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.

Is the member's first point of contact into Care Management. Assesses and identifies the needs and evaluates to determine if the member needs complex care management. If the needs are not complex, assists the member to meet their health care needs.

Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.

Acts proactively on member s behalf with routine benefits, gaps in care and prior authorization processes.

Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.

Identifies barriers and social determinants of health and assists to address or eliminate these barriers.

Manages a caseload of approximately 150-300 members with stable but complex conditions or rising risk related to chronic conditions.

Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.

Performs other duties as assigned.