Medical Care Coordinator

Job Summary

A healthcare professional with a customer centric focus to coordinate, outreach to and respond to members regarding issues and questions related to medical conditions, benefits and coverage criteria. 1) Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.

2) Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc. 3) Act proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. 4.)

Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.

Essential Functions

• Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.
• Is the member's first point of contact into Care Management. Assesses and identifies the needs and evaluates to determine if the member needs complex care management. If the needs are not complex, assists the member to meet their health care needs.
• Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
• Acts proactively on member's behalf with routine benefits, gaps in care and prior authorization processes.
• Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.
• Identifies barriers and social determinants of health and assists to address or eliminate these barriers.
• Manages a caseload of approximately 150-300 members with stable but complex conditions or rising risk related to chronic conditions.

Qualifications

Required

• Associate's Degree Associate's Degree with a health care focus or LPN
• Skills/knowledge/abilities typically gained through less than 2 years of related work experience in a clinical office or health insurance setting.
• 3 years of relevant experience Working in an organization of size and complexity comparable to Corewell Health or managed care organization

Preferred

• 5 years of relevant experience Related work in a clinical office or health insurance setting

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status
• Primary Location
• SITE - 2427 Hillcrest Parkway - Altoona
• Department Name

Benefits

Group Health Cooperative of Eau Claire - PH Managed Benefits:

• Employment Type
• Full time
• Shift
• Day (United States of America)
• Weekly Scheduled Hours
• 40
• Hours of Work

8:00 a.m. to 5 p.m.

• Days Worked
• Monday to Friday
• Weekend Frequency
• N/A

Current Corewell Health Team Members

Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.