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Patient Care Coordinator - Health Plan Office

Patient Care Coordinator - Health Plan Office

Job Description

  1. The Patient Care Coordinator provides office and referral management support services and assists the Case Managers in obtaining medical records, documenting all case information in the system, performing data entry into appropriate databases for monitoring and tracking, and following up on phone calls as directed by the Case Managers. 
  2. The Patient Care Coordinator serves as a contact between members, physicians, providers, and staff, processing the initial intake of information, assisting with authorization functions and gathering information. 
  3. This position is responsible for providing effective, efficient and courteous interaction with facilities, providers, members/family and other staff, under the direction of the licensed Registered Nurse. 


Position Responsibilities:

  • Receive referral request via fax, phone, or electronically and data enters new case information into the authorization system.
  • Collects additional information from members and/or providers/facilities to complete referral information.
  • Authorize requested services according to Authorization guidelines, performing data entry into the authorization system, and verifying eligibility. 
  • Contacts the Health Networks and/or Customer Service regarding health network enrollments.
  • Assists the authorization Nurse in gathering medical records, obtaining appropriate coding for diagnosis and procedures, and follow up on phone calls as directed by the authorization Nurse.
  • Documents all contacts and case information in the system, using the standard charting format.
  • Performs data entry into the appropriate databases for monitoring and tracking, trending of events and other relevant databases as needed. 

Job Requirements

Possess the Ability To:

  1. Verbally communicate adequately to obtain relevant needed data from members, providers, etc., and record and summarize findings.
  2. Develop and maintain effective working relationships with all levels of staff, other programs, community agencies, providers and members.
  3. Effectively utilize computer and appropriate software and interact as needed with Information Systems.
  4. Utilize prior authorization protocols to determine when to refer matters to a licensed staff person.

Knowledge of:

  • Medical Terminology.
  • CPT/ICD-9 coding.
  • Medi-Cal - benefits and regulations.
  • Experience calling hospitals
  • Experience in admitting & knows insurance

About the Agency:
Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Insurance, Admin - Clerical
Education Not Specified
Experience At least 3 year(s)
Manages Others No
Industry Healthcare - Health Services, Insurance, Managed Care
Required Travel None
Job ID 09A*
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Patient Care Coordinator - Health Plan Office

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