Managed Care Coordinator

Job Summary

A company is looking for a Managed Care Coordinator to support Health Services and Utilization Management functions.

Key Responsibilities

• Review service requests for completeness and collect non-clinical data
• Handle initial screening for pre-certification requests from physicians and members
• Prepare and document cases for clinical review and coordinate communications with members and providers

Required Qualifications

• High School Diploma required; some college preferred
• 1-2 years of experience in customer service or medical support preferred
• Knowledge of medical terminology required
• Prefer knowledge of contracts, enrollment, billing, and claims coding/processing
• Prefer knowledge of Managed Care principles