Managed Care Coordinator – I

Horizon Connect @ Wall BCBSNJ

. 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.

Posted 9/15/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $44,600 - $59,745 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical terminology and customer service within a healthcare setting, with a strong focus on case management, claims processing, and member engagement. Proficient in coordinating care and resolving issues while adhering to managed care principles.

Highest-signal resume keywords

Medical Terminology KnowledgeCustomer Service ExperienceClaims Coding/Processing KnowledgeStrong Analytical SkillsGood Oral and Written Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingPre-Certification ScreeningData CollectionCase ManagementProblem Resolution

Soft Skills

Interpersonal SkillsTeam PlayerDecision Making

Tools & Technologies

Personal ComputerApplicable Software Systems

Certifications & Qualifications

High School Diploma/GED

Industry Keywords

Managed Care PrinciplesMedicaid CMPreventive Health ActivitiesReferral ManagementHealth Assessments

About the role

Key responsibilities & impact

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.
Prepare, document and route cases in appropriate system for clinical review.
Initiates call backs and correspondence to members and providers to coordinate and clarify benefits and case completion.
Reviews professional medical/claim policy related issues or claims in pending status.
Acts as liaison with providers, members and Care Managers.
Authorizes services based upon scripts or algorithms used for pre-review screening under clinical staff oversight.
Handles initial screening for pre-certification requests based on scripts and workflows.
Assists members with finding providers, resolving problems, answering questions, filing appeals, and obtaining services.
Makes outbound calls to engage members in Case Management and complete necessary health assessments.
Educates members regarding preventive health activities and services.
Assists members with appointments, transportation, PCP and demographic changes, and new ID cards.
Triages and distributes referrals and provider faxes.
Reviews medical, dental and vision claims and addresses gaps in members' preventive care.
Performs other relevant tasks as assigned by Management.

Requirements

What you’ll need

High School Diploma/GED required.
Prefer 1-2 years customer service or medical support related position.
Requires knowledge of medical terminology, Preferred – Medicaid CM.
Requires Good Oral and Written Communication skills.
Requires ability to make sound decisions under the direction of Supervisor.
Prefer knowledge of contracts, enrollment, billing & claims coding/processing.
Prefer knowledge Managed Care principles.
Prefer the ability to analyze and resolve problems with minimal supervision.
Prefer the ability to use a personal computer and applicable software and systems.
Team Player, Strong Analytical, Interpersonal Skills.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement