Case Management Coordinator

Job Description :

In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group.

Responsibilities include, but not limited to :

Case management following Policy and Procedures (P&P)

Assure authorization is on file for all services approved by the delegated entity prior to claims payment

Notify the CM nurse if patients are out-of-network

Coordinate and request authorizations with IPA

Enter and process authorization requests

File and process medical records

Establish and maintain authorization files, project files and other highly confidential information

Screen telephone calls and handle appropriately

Prepare package and data for Joint Operation Committee (JOC) meetings

Assure the programs, policies, procedures, and operations are adhered as guided

Participate in special projects

Work closely with UM Manager and provide support when needed

Qualifications : LVN Preferred

Must have medical background and medical terminology knowledge

Must be committed to a long-term stay with the company

Must have good written and communication skills

Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment

Computer literacy required, including proficient use of Microsoft Work, Excel, and Outlook

Typing skills of at least 50 wpm

Monday – Friday, 8 : 30am – 5pm

Starting rate at $23.00 / hour for non-licensed

Benefits : Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Paid Time Off

401K Match