[Hiring] Care Coordinator @All Care To You

Role Description

The Care Coordinator is responsible for supporting the care management team. The Coordinator will work directly with the Utilization Management Nurse(s) in day-to-day operations. This position is ideal for someone who is a strong communicator and team player.

• Assists and monitors with the processing of authorization requests.
• Documents, updates and finalizes referrals daily while assuring that:
  • Appropriate internal/external referral providers are utilized.
  • Members are eligible and have benefits coverage.
  • Correct CPT/ICD-10 codes have been entered.
  • Accurate records of all dates and other required fields are entered.
  • Supporting clinical data for the referrals is entered.
  • All referrals are processed within the designated timeframe.
• Looks up information in the DOFR and EOC as needed.
• Follows Coordinator guidelines for authorization requests.
• Coordinates, identifies, and routes referrals that require review to Utilization Management Nurses as appropriate.
• Assists with data entry, updates, and corrections per the requested time frame.
• Interacts with UM nurses to assist them with requests and provides timely follow through.
• Takes incoming calls for the department.
• Calls providers, members, and/or health plans.
• Maintains PHI and compliance with the Health Insurance Portability and Accountability Act (HIPAA).
• Proactively takes action to solve problems.
• Attends meetings as requested.
• Completes required training.
• Other duties as needed.

Qualifications

• 2 years healthcare administration experience
• 3 years customer service experience
• HMO/Medical Group experience preferred
• Must be able to work 8 - 5 PM Pacific Standard Time
• Bilingual proficiency preferred
• Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe
• Strong ability to multi-task and work in a fast-paced environment
• Strong ability in problem-solving
• Ability to work in an extremely confidential environment
• Strong written and verbal communication skills
• Technology savvy and highly organized