Managed Care Coordinator I

Job Summary

A company is looking for a Managed Care Coordinator I-Utilization Management.

Key Responsibilities:

• Review service requests for completeness and collect necessary clinical and non-clinical data
• Prepare and document cases for clinical review, coordinating with members and providers
• Act as a liaison between providers, members, and Care Managers while performing other relevant tasks as assigned

Required Qualifications:

• High School Diploma/GED required
• 1-2 years of customer service or medical support experience preferred
• Knowledge of medical terminology is required; knowledge of Medicaid CM is preferred
• Familiarity with contracts, enrollment, billing, and claims coding/processing is preferred
• Understanding of Managed Care principles is preferred