Care Coordinator NE BH-Paragould (Greene Co)
Position Title: Care Coordinator
Department: Coordinated Care
Full Time/Part Time, Exempt/Nonexempt: Full Time, Non-Exempt
Reports To: Supervisor, Care Coordination
Position Summary
The Managed Care Coordinator plays a crucial role in facilitating and coordinating the delivery of managed care services within an organization. This position is responsible for managing and overseeing the administrative processes associated with managed care plans, ensuring compliance with relevant regulations, and ensuring effective communication between healthcare providers, insurance companies, and patients.
Key Responsibilities
Coordinate Managed Care Services: 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 plans and 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.
Insurance Verification: 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 services.
Collaborate with insurance companies and healthcare providers to ensure availability and quality of services.
Facilitate coordination with diverse healthcare providers for diagnostics, ambulatory care, and hospital services.
Member Advocacy: Serve as a point of contact for members, addressing questions, concerns, and complaints related to managed care services, and advocate 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.
Compliance and Documentation: 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 applicable program standards and assist with resources needed or barriers to accessing treatment.
Continuous Improvement: Identify opportunities for process improvement and efficiency enhancement in managed care operations. Propose and implement strategies to optimize service delivery and enhance patient satisfaction.
Collaborate with external and internal stakeholders to ensure the highest level of service efficiency.
Education And Experience
High School diploma and one (1) year experience in the mental health field.
Bachelor's degree in a relevant field such as healthcare, social work, psychology or social services; other healthcare-related fields preferred.
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.
License/Certification
A valid driver's license and up-to-date automobile insurance must meet the minimum requirements in your state.
Physical Requirements
Must be able to drive and perform quarterly visits to 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.
Note: This job description is not intended to be exhaustive. It aims to outline the fundamental duties and minimum qualifications required for this position. The individual(s) holding this position may be assigned additional job-related responsibilities beyond those specified. Management reserves the right to assign or reassign responsibilities to this position at any time. Reasonable accommodations will be provided as required by applicable laws.