Care Management Coordinator

• Overview The challenges of affordable healthcare continue to create new opportunities.
• Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.
• These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
• The MJHS Difference At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
• We foster collaboration, celebrate achievements, and promote fairness for all.
• Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.
• Benefits include: Tuition Reimbursement for all full and part-time staff Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members Two retirement plans!
• 403(b) AND Employer Paid Pension Flexible spending And MORE!
• MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

The Care Management Coordinator is expected to ensure high quality, cost-effective care and services for Elderplan/HomeFirst members through support of professional Care Management activities. The position supports all aspects of care coordination for our Medicaid, and/or dual product members in compliance with all departmental and CMS/DOH regulatory requirements. The position requires excellent communication and organizational skills to facilitate superior care management and to act as a liaison between the members, the care management team, and the vendors. · Processes all newly enrolled cases according to established EP/HF Coordinated Care team workflows and maintains integrity of members’ files · Receives and processes requests and inquiries through interdepartmental communication system regarding covered/ non covered services/supplies · Receives and processes initial requests and inquiries regarding pre-authorization of services/supplies. · Coordinates and provides service authorizations to vendors · Accurate and timely data entry support as defined by departmental workflows · Participates in scheduled team meetings

Qualifications

· High School Diploma or equivalent; college degree preferred. · One year prior managed care experience required. · Prior experience in a health care setting preferred. · Familiarity with utilization management/case management. Min USD $40,000.00/Yr. Max USD $44,000.00/Yr.