Metropolitan Jewish Health System
Location
New York
Salary
$40,000 - $44,000 / YEAR
This role ensures high-quality, cost-effective care and services for members by supporting professional Care Management and Clinical Service activities, focusing on care coordination for Medicare, Medicaid, and dual product members. The coordinator processes new cases, handles inquiries regarding covered services, manages pre-authorization requests, and provides service authorizations to vendors.
A High School Diploma or equivalent is required, though a college degree is preferred for this position. Candidates must possess at least one year of prior managed care experience, with prior experience in a healthcare setting being preferred, along with familiarity with utilization management or case management.
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
· 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.
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