Managed Care Coordinator

Job Summary

A company is looking for a Managed Care Coordinator I to support Clinical Operations functions and act as a liaison among various stakeholders.

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
• Assist members with provider access, problem resolution, and health assessments

Required Qualifications:

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