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Form of work
SalaryProgram Coordinator, temp to permanent.
Remote-IL, $23/hour, Shift: 8-5pm CST
Position Purpose:
Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
Job Description:
- Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility.
- Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
- Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
- Coordinate services with community-based organizations. Attend marketing and outreach meetings as directed to represent the plan.
- Produces and mails routine CM letters and program educational material.
- Enter assessments and authorizations into the system.
Education/Experience:
- High school diploma/GED required.
- Prior experience in a managed health plan or medical facility
- Prior call center experience
- Thorough knowledge of customer service and operation of office equipment such as a personal computer.
- Knowledge of medical terminology.
- MS Word, Excel, Outlook experience
Day to Day Responsibilities:
- Outreach members telephonically
- Answer incoming calls from members or associates.
- Create Case, Create Tasks, Create Referrals in member’s chart
- Complete screenings and document properly
- Filter Excel Spreadsheet
- Utilize Outlook Calendar for daily planning.
- Assist Member is downloading App and Onboarding
- Educating members on Digital Case Management
Performance expectations/metrics:
- Handle 80-100 calls per week (outbound and inbound calls)
- Complete screenings on all new members
- Document all member interactions and outreach
- Onboard 5-10 members/week
