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Care Management Coordinator
Location
United States
Posted
7 days ago
Salary
$22 - $33 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Care Management Coordinator
Highmark Health
Role Description This job performs accurate and timely processing of pre-certification requests for authorization of medically necessary health care services, at the appropriate level of care, based on the benefits for the line of business, and in compliance with the organization's policies, procedures and regulatory requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review type, clinical information, and decision timeframes. Follows policies and procedures to assure case completion and compliance with state and federal regulatory agencies. Maintains or exceeds department standards for call volume, response time and related production and quality measures. May interact with other departments and providers to resolve cases. Qualifications - 3 years of experience in customer service - 3 years of experience in typing, keyboard and computer skills - 3 years of work experience in medical terminology - Preferred: Work experience with ICD-9 and/or CPT coding - Required: High School diploma / GED - Preferred: Associates degree or certification in a health related occupation Requirements - Proactively inform designated individuals of the status of work assignment to assure decision timeframes and notification requirements are met. - Communicate effectively with Utilization Management Staff, providers, other internal and external customers and management. - Route Cases Based on Established Guidelines. - Provide accurate and timely routing of service requests to the nurse reviewer to assure that the decision and notification timeframes are in compliance with regulatory guidelines. - Process service requests meeting established guidelines, and document and route requests that are not permitted. - Request additional information verbally and in writing when the information provided is not adequate to make a medical necessity determination. - Escalate appropriate cases to leadership that require a clinical review and/or other intervention. - Assist with reporting as directed. - Participate in precepting of new employees, as assigned. - Maintain or exceed department call center standards. - Adhere to line of business phone standards to assure regulatory requirements are met. - Utilize phone functions to monitor the number of calls in queue and wait time. - Utilize daily phone standard reports to assess opportunities for self-improvement. - Meet or exceed standards for other production and quality measures. - Other duties as assigned or requested. Benefits - Pay Range Minimum: $21.96 - Pay Range Maximum: $32.95 - Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. All employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
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