Medical Care Coordinator

Job Title: Medical Care Coordinator

Job Specific Information: Associates degree with health care focus, or LPN

Location/locations: Remote position Office 1231 East Beltline, Grand Rapids MI

Shift Time: Days

Hours: 8-4:30

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 members 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.

Notices:

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  Client is committed to granting reasonable accommodations in accordance with applicable laws.

  
  


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  Once confirmed, all time is submitted through VNDLY by your traveler. Please educate and train them on this. It is also our platform for invoicing and payments so if this step is not complete it will impact your agency's payment from Client.

  
  


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  If a Service Provider or Contingent Worker fails to take action required for accurate invoicing within 45 days following the end of a pay cycle in which services were provided, then Client shall not be obligated to make payment to Service Provider for those services.

  
  

  
  

  Examples of action: If staff provided services ending the week Sep 3, 2023 and Service Provider does not submit accurate timesheets no later Oct 18, 2023, Client shall not be obligated to pay for the service provided during that timeframe.

  
  
  


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  Supplier must take system action to implement agreed upon rate changes prior to the week the change becomes effective.

  
  


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  It is highly recommended that timesheet reconciliation and issue inquiry/correction is performed by the supplier prior to the 45 days.

  
  


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  No other forms of invoicing are accepted outside of our timesheet approval process.

  
  

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