Care Management Coordinator

Overview

The Care Management Coordinator (CMC) supports an assigned Medical Care Management Nurse.

• Work directly with assigned Medical Care Management Nurse.
• Contacts members by phone, mail, or email as directed by Medical Care Management Nurse.
• Responsible for generating reports and documents that pertain to member case management.
• Act as liaison between the reinsurance department and assigned Nurse Care Management team regarding various reports in the claims/UR system.
• Act as point of contact between Client Management and Nurse Care Manager.
• Contact providers to obtain clinical documentation for members.
• Maintain strict HIPAA Confidentiality; follow all internal policies and procedures to maintain the confidentiality for all members and member data.
• Follow written criteria, policies and procedures in reviewing and processing daily referrals for outpatient and inpatient medical care as needed to back up UR Coordinator.
• Remain in constant daily contact with other Care Management Department.
• Work independently on assigned tasks and activities, based on established policies and procedures.
• Perform other duties and responsibilities as assigned by the Management.

• Strong communication skills, effective and accurate written and verbal form.
• Ability to evaluate and comprehend clinical documentation.
• Strong customer service oriented skills for both internal staff and external clients.
• Strong organizational skills which support timely and well documented action to manage concurrent deadlines and multiple priorities.
• Keyboarding skills and the ability to utilize computer equipment and software are required as is experience with other types of standard office equipment.
• Strong working knowledge of Microsoft Office, excel, windows based products and software specific to document scanning.
• Medical terminology required.
• Working knowledge of ICD-10, HCPCS and CPT coding.
• Ability to work independently and within a team environment.
• Knowledge and ability to utilize evidence based medical guidelines.
• Durable Medical Equipment knowledge preferred.
• Must be able to, with reasonable accommodation, sit for extended periods of time; view and input data on PC for extended periods of time; stand, stoop, lift, carry and walk on an intermittent basis.
• Must be able to work within core hours of operation 8 am to 5 pm, Tues
  - Sat.

Supervisory Responsibilities:

This job has no supervisory responsibilities.