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NJM Insurance Group logo
NJM Insurance Group

More Than 100 Years of Earning Trust

Managed Care Coordinator

Care CoordinatorGeneralFull TimeRemoteJuniorTeam 1,001-5,000Since 1913H1B No SponsorCompany SiteLinkedIn

Location

New Jersey

Posted

18 days ago

Salary

$44.6K - $59.7K / year

Seniority

Junior

High School1 yr expEnglish

Job Description

Managed Care Coordinator

NJM Insurance Group

• Performs review of service requests for completeness of information • Collection and transfer of non-clinical data • Acquisition of structured clinical data from physicians/patients • Prepare, document and route cases in appropriate system for clinical review • Initiates call backs and correspondence to members and providers to coordinate and clarify benefits • Reviewing professional medical/claim policy related issues or claims in pending status • Acts as liaison with providers, members and Care Managers • Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence • Assists members with finding providers, resolving problems and answering questions • Makes outbound calls to engage members in Case Management and complete health assessments • Educates members regarding preventive health activities and services • Assists members to make appointments with their PCP, specialists, and/or transportation • Review medical, dental and vision claims and address gaps in member's preventative care

Job Requirements

  • High School Diploma/GED required
  • Prefer 1-2 years customer service or medical support related position
  • Requires knowledge of medical terminology
  • Requires Good Oral and Written Communication skills
  • Requires ability to make sound decisions under the direction of Supervisor
  • Prefer knowledge of contracts, enrollment, billing & claims coding/processing
  • Prefer knowledge Managed Care principles
  • Prefer the ability to analyze and resolve problems with minimal supervision
  • Prefer the ability to use a personal computer and applicable software and systems
  • Team Player, Strong Analytical, Interpersonal Skills

Benefits

  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement

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