Case Management Coordinator

Job Description : In the UM department, Case Management Coordinator is to assist with the coordinating of the day-to day activities in the medical group, request for authorization for ancillary services, and certify the group is utilizing the most cost effective provider. Also, identify patients found in out-of-network facilities and send the information timely to the concurrent-review nurse for coordination with the hospital and group. Responsibilities include, but not limited to : Case management following Policy and Procedures (P&P) Assure authorization is on file for all services approved by the delegated entity prior to claims payment Notify the CM nurse if patients are out-of-network Coordinate and request authorizations with IPA Enter and process authorization requests File and process medical records Establish and maintain authorization files, project files and other highly confidential information Screen telephone calls and handle appropriately Prepare package and data for Joint Operation Committee (JOC) meetings Assure the programs, policies, procedures, and operations are adhered as guided Participate in special projects Work closely with UM Manager and provide support when needed Qualifications : LVN Preferred Must have medical background and medical terminology knowledge Must be committed to a long-term stay with the company Must have good written and communication skills Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment Computer literacy required, including proficient use of Microsoft Work, Excel, and Outlook Typing skills of at least 50 wpm Monday – Friday, 8 : 30am – 5pm Starting rate at $23.00 / hour for non-licensed Benefits : Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K Match