Medical Management Care Coordinator needed for a contract opportunity with Yoh’s client located in San Jose, CA!
Top Skills You Should Possess:
- Previous experience in healthcare setting required
What You’ll Be Doing:
- Perform non-clinical supportive duties related to utilization management (UM) and care coordination for members; routine supportive duties include but are not limited to data entry into system software applications, managing department telephone queues and assisting with quality monitoring projects for all lines of business
- Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent manner
- Perform complete, accurate and consistent data entry into system software applications in accordance with policies, procedures and instruction from Health Services Management
- Identify authorization requests for line-of-business, urgency level, type of service, and assess for complete/incomplete record submission
- Facilitate processing of Authorization Determination letters including approval, denial, delay and modify notifications to providers and members within regulatory processing timeframes
- Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfaction
- Develop effective and professional working relationships with internal and external stakeholders and partners. Communicate effectively with members and providers orally and in writing
- Assist in gathering and processing data for internal required reports and analysis
- Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions
What You Need to Bring to the Table:
- High school diploma or GED
- Minimum two years of experience in a health care setting in positions requiring interaction with members and/or providers
- Knowledge of health plan benefits, process and operations related to commercial, Medi-Cal and/or Medicare programs
- Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support department operations as dictated by business needs
- Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance
- Ability to work within an interdisciplinary team structure
- Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs
- Ability to use a keyboard with moderate speed and a high level of accuracy
- Excellent communication skills including the ability to express oneself clearly and concisely when providing service to internal departments, members, providers and outside entities over the telephone, in person or in writing
What’s In It For You?
We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.
- Medical, Dental & Vision Benefits
- 401K Retirement Saving Plan
- Life & Disability Insurance
- Direct Deposit & weekly EPayroll
- Employee Discount Programs
- Referral Bonus Programs
What are you waiting for? Apply Now!
Recruiter: Jennifer Andersen
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Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.