Care Management Support Coordinator II

Immediate need for a talented Care Management Support Coordinator II. This is a 12+months contract opportunity with long-term potential and is located in McAllen TX , Dallas TX (remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-84784

Pay Range: $17 - $18.50 /hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift - : 8-5 and OT as needed, maybe mandatory  
• Training is available to make sure that the contractor is ready to be on their own and can be adjusted 
• Flex schedules
• Work week: Monday - Friday
• Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service
• Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
• May apply working knowledge of assigned health plan(s) activities and resources
• Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols
• Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship
• Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed
• Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs
• Performs other duties as assigned
• Complies with all policies and standards

Key Requirements and Technology Experience: 

• Key Skills; Authorization, Prior authorization, pre authorization
• Requires a High School diploma or GED
• Requires 1 – 2 years of related experience
• Data Entry and document review
• Process authorization
• Daily worklist
• Outbound phone call to verify but not actively on the phone
• The Centralized Authorization Team consists of the processing of authorizations for LTSS, in which we are now at a 3-4  BD TAT for the processing of Ltss/ SK/SH/MMP authorizations. 
• Contingent workers to assist with each of these areas as well as cross train them to be able to assist in multiple functions. 
• The authorization team continues to experience a high task and authorization volume as the number of VIP providers has increased.
• PC’s will aid with processing authorizations for the upcoming LTSS Billing Matrix changes.
• This allows us the opportunity to service our members timely and within expected TATs
•  Teams, Excel,
•  Remote experience, Excel
• Disqualifiers: no longevity in jobs
• 2 years of medical experience in authorizations or claims processing practices in managed care setting.
• Knowledge of customer service, medical terminology,
• Knowledge of operation of office equipment.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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