Managed Care Coordinator I, Behavioral Health

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 10/6/2026full-timeRemote • New Jersey • United StatesMid-LevelSenior💰 $44,600 - $59,745 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical terminology, customer service, and claims processing while effectively communicating with members and providers. Capable of making sound decisions and resolving issues in a fast-paced environment under supervision.

Highest-signal resume keywords

Medical Terminology KnowledgeCustomer Service ExperienceClaims Coding/Processing KnowledgeGood Oral and Written Communication SkillsStrong Analytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingPre-Certification ScreeningRegulatory Compliance ReviewData Collection and TransferHealth Assessment Coordination

Soft Skills

Interpersonal SkillsTeam PlayerProblem-Solving AbilityDecision-Making Under Supervision

Tools & Technologies

Personal ComputerApplicable Software and Systems

Industry Keywords

Medicaid Case ManagementManaged Care PrinciplesPreventive Health ActivitiesMedical Claims ReviewProvider Liaison

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.
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 when appropriate.
Handles initial screening for pre-certification requests under the oversight of clinical staff.
Assists members with finding providers, resolving problems and answering questions regarding services and appeals.
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 preventive care.
Reviews medical and administrative documentation for accuracy, grammar, and regulatory compliance.
Performs initial screening of determination letters before distribution.
Makes sound, timely decisions under the direction and supervision of a designated Supervisor.
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.

Benefits

Comp & perks

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