Empower Healthcare Solutions

Care Coordinator

• Oversee and facilitate the coordination of managed care services, including verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services
• Deliver personalized health education and coaching to members based on identified concerns outlined in treatment and service plan
• Provide member support access in addressing social determinants of health, such as facilitating access to exercise opportunities and nutritious food
• Verify insurance coverage and benefits for patients, ensuring accurate and up-to-date information is obtained and documented
• Conduct utilization reviews to evaluate the medical necessity and appropriateness of requested services, ensuring compliance with established guidelines and policies
• Collaborate with insurance companies and healthcare providers ensuring availability and quality of services
• Facilitate coordination with diverse healthcare providers for diagnostics, ambulatory care, and hospital services
• Serve as a point of contact for members, addressing their questions, concerns, and complaints related to managed care services, and advocating for their needs within the organization
• Encourage initiatives aimed at improving the health of patients and their communities, including outreach efforts, quality improvement initiatives, and patient panel management
• Coordinate community-based management of medication therapy
• Ensure compliance with applicable laws, regulations, and contractual obligations related to managed care services
• Maintain accurate and complete documentation of all interactions, authorizations, and communications
• Ensure compliance with the PCSP and assist with any resources needed or barriers to accessing treatment
• Identify opportunities for process improvement and efficiency enhancement in managed care operations
• Propose and implement strategies to optimize service delivery and enhance patient satisfaction
• Collaborate with both external and internal stakeholders to ensure the highest level of service efficiency

Care Coordinator, SW DD – Hope

• Oversee and facilitate coordination of managed care services, including verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services
• Deliver personalized health education and coaching to members based on identified concerns outlined in treatment and service plans
• Support members in addressing social determinants of health, including facilitating access to exercise opportunities and nutritious food
• Verify insurance coverage and benefits for patients and maintain accurate information
• Conduct utilization reviews to evaluate medical necessity and appropriateness of requested services
• Collaborate with insurance companies and healthcare providers to ensure availability and quality of services
• Coordinate with diverse healthcare providers for diagnostics, ambulatory care, and hospital services
• Serve as a point of contact for members, addressing questions, concerns, and complaints and advocating for their needs
• Encourage health improvement initiatives, outreach efforts, quality improvement initiatives, and patient panel management
• Coordinate community-based management of medication therapy
• Ensure compliance with applicable laws, regulations, contractual obligations, and the PCSP
• Maintain accurate and complete documentation of interactions, authorizations, and communications
• Identify opportunities for process improvement and efficiency enhancement
• Propose and implement strategies to optimize service delivery and enhance patient satisfaction
• Collaborate with external and internal stakeholders to ensure service efficiency

Care Coordinator, SW DD – Hope

Care Coordinator – Central DD