Care Coordinator

• Perform review of service requests for completeness, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
• Prepare, document and route cases in the appropriate system for clinical review.
• Initiate callbacks and correspondence to members and providers to coordinate and clarify benefits and case completion.
• Review professional medical/claim policy-related issues or claims in pending status.
• Act as liaison with providers, members, Care Managers, Physicians, Delegates, Operational Business members and Member Service Coordinators.
• Authorize services based on scripts or algorithms used for pre-review screening, under clinical staff oversight.
• Handle initial screening for pre-certification requests via incoming calls or correspondence based on scripts and workflows.
• Assist members with finding providers, resolving problems, answering questions, filing appeals, and obtaining services.
• Make outbound calls to engage members in Case Management and complete health assessments.
• Educate members regarding preventive health activities and services.
• Assist members with appointments, transportation, PCP and demographic changes, and new ID cards.
• Triage and distribute referrals and provider faxes.
• Review medical, dental and vision claims and address gaps in preventive care.
• Review medical and administrative documentation for accuracy, grammar and regulatory compliance.
• Perform initial screening of determination letters before distribution.
• Make sound, timely decisions under Supervisor direction and perform other assigned tasks.

Managed Care Coordinator

• 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.

Care Coordinator jobs in Connecticut

Managed Care Coordinator

Managed Care Coordinator – I