Job Details

  • Title: Managed Care Coordinator
  • Code: RCI-ZON-7553-1
  • Location: Farmingdale New Jersey (NJ) 07727
  • Posted Date: 06/12/2019
  • Duration: 6 Months
  • Status: Open
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  Job Description

This position supports the workers-compensation claim operations and utilization management functions and acts as a liaison between claimants, providers, external claim representatives, and clients.

Responsibilities:

- Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
- Handles initial screening for precertification requests from physicians/claimants via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
- Performs three-point contact, directs care into the network, follows up on status of treatment, corresponds with providers and documents the file consistently.
- Coordinate the treatment plans proposed by providers, in accordance with established HCS protocols. Upon collection of clinical and non-clinical information CC can authorize medical treatment and associated diagnostic testing based upon scripts or algorithms used for pre-review screening.
- Acts as liaison with client to identify issues and problems relating to care management and claim processing and forwards concerns to appropriate parties, when necessary.
- Initiates calls and correspondence to claimants, providers, and the client to coordinate courses of treatment.
-Perform other relevant tasks as assigned by management.
* Non Clinical staff are not responsible for conducting any UM review activities that require interpretation of clinical information.

Qualification:

- Prefers a bachelor’s degree.
- Requires a minimum of two years business experience, preferably in a medical support related position or health insurance environment.
- Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint), Should be knowledgeable in the use of intranet and internet applications.
- Requires knowledge of medical terminology.
- Prefers knowledge of understanding of case management, philosophy and process.
- Strong typing, data entry and numeric keypad skills necessary.