Case Management Coordinator

Job Description:

In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group.

 Responsibilities include, but not limited to:

• Case management following Policy and Procedures (P&P)
• Assure authorization is on file for all services approved by the delegated entity prior to claims payment
• Notify the CM nurse if patients are out-of-network
• Coordinate and request authorizations with IPA
• Enter and process authorization requests
• File and process medical records
• Establish and maintain authorization files, project files and other highly confidential information
• Screen telephone calls and handle appropriately
• Prepare package and data for Joint Operation Committee (JOC) meetings
• Assure the programs, policies, procedures, and operations are adhered as guided
• Participate in special projects
• Work closely with UM Manager and provide support when needed

Qualifications:

• LVN Preferred
• Must have medical background and medical terminology knowledge
• Must be committed to a long-term stay with the company
• Must have good written and communication skills
• Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment
• Computer literacy required, including proficient use of Microsoft Work, Excel, and Outlook
• Typing skills of at least 50 wpm

Monday – Friday, 8:30am – 5pm
Starting rate at $23.00/hour for non-licensed

Benefits:
Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
Paid Time Off
401K Match