Care Coordinator Central DD-Benton (Saline Co)

Summary

Empower Healthcare Solutions is a healthcare organization seeking a Care Coordinator to facilitate and coordinate managed care services. The role manages eligibility verification, referrals, authorizations, member advocacy, provider coordination, compliance documentation, health education, and process improvement.

Responsibilities

• Oversee and facilitate the coordination of managed care services, including verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services
• Deliver personalized health education and coaching to members based on identified concerns outlined in treatment and service plan. requested services, ensuring compliance with established guidelines and policies
• Provide member support access in addressing social determinants of health, such as facilitating access to exercise opportunities and nutritious food
• Verify insurance coverage and benefits for patients, ensuring accurate and up-to-date information is obtained and documented
• Conduct utilization reviews to evaluate the medical necessity and appropriateness of
• Collaborate with insurance companies and healthcare providers ensuring availability and quality of services
• Facilitate coordination with diverse healthcare providers for diagnostics, ambulatory care, and hospital services
• Serve as a point of contact for members, addressing their questions, concerns, and complaints related to managed care services, and advocating for their needs within the organization
• Encourage initiatives aimed at improving the health of patients and their communities, including outreach efforts, quality improvement initiatives, and patient panel management
• Coordinate community-based management of medication therapy
• Ensure compliance with applicable laws, regulations, and contractual obligations related to managed care services. Maintain accurate and complete documentation of all interactions, authorizations, and communications
• Ensure compliance with the PCSP and assist with any resources needed or barriers to accessing treatment
• Identify opportunities for process improvement and efficiency enhancement in managed care operations. Propose and implement strategies to optimize service delivery and enhance patient satisfaction
• Collaborates with both external and internal stakeholders to ensure the highest level of service efficiency

Skills

• High School diploma and One (1) year experience in the mental health field
• Knowledge of managed care principles, processes, and regulations
• Familiarity with health insurance terminology, coverage, and benefit structures
• Strong organizational skills with the ability to manage multiple tasks simultaneously
• Excellent communication and interpersonal skills to effectively collaborate with internal and external stakeholders
• Detail-oriented and ability to maintain accurate records and documentation
• Proficiency in using computer systems and software applications relevant to managed care operations
• A valid driver's license and up to date automobile insurance must meet the minimum requirement in your state
• Must be able to drive and perform quarterly visits to their members
• Prolonged periods of sitting at a desk and working on a computer
• The ability to occasionally lift objects weighing up to 15 pounds is required
• Bachelor's degree in a relevant field such as healthcare, social work, Psychology or social services and other healthcare related field preferred

Qualifications

Must Haves

• High School diploma and One (1) year experience in the mental health field
• Knowledge of managed care principles, processes, and regulations
• Familiarity with health insurance terminology, coverage, and benefit structures
• Strong organizational skills with the ability to manage multiple tasks simultaneously
• Excellent communication and interpersonal skills to effectively collaborate with internal and external stakeholders
• Detail-oriented and ability to maintain accurate records and documentation
• Proficiency in using computer systems and software applications relevant to managed care operations
• A valid driver's license and up to date automobile insurance must meet the minimum requirement in your state
• Must be able to drive and perform quarterly visits to their members
• Prolonged periods of sitting at a desk and working on a computer
• The ability to occasionally lift objects weighing up to 15 pounds is required

Nice to Haves

• Bachelor's degree in a relevant field such as healthcare, social work, Psychology or social services and other healthcare related field preferred

Benefits

• Fully Remote