Long Term Services Coordinator - Health Plan

Location: Pittsburgh, PA
Date Posted: 02-01-2018
Long Term Services Coordinator - Managed Care
Pittsburgh, PA
*** This is a Full-Time, Benefits Available, CONTRACT-TO-HIRE opportunity,
expected to convert into a PERMANENT role after roughly 6 months! ***
Your Job Summary:
Long Term Services Coordinators are the front-lines of providing excellence in customer care to both internal and external clients.  They are responsible for ensuring that appropriate member treatment plans are followed and proactively identifying ways to improve the health of our members and meet quality goals.  The Coordinator also has direct contact with members or their families, and medical providers throughout the region, primarily for the purpose of scheduling support.  The Coordinator will function as a form of liaison between the health plan, the contracted provider organization, and the health plan members.  They will facilitate communication between all three parties to assist in the direct coordination of Long Term Service and Support (LTSS) care for members. 

Your Reward:  

Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.

Your Background:  
Requires an education level of at least a high school diploma or GED; Associate’s or Bachelor’s degree is a plus.
Requires exceptional phone / customer service skills, as well as very strong computer user skills.
Around 1-2 years of healthcare experience, preferably in home health, long term care, provider office setting, or other healthcare support role with heavy computer & phone use.
Prefer basic familiarity with Medical terminology (1-3 years direct experience).
Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a plus.
Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new computer system applications.
Must have a minimum of 30-40 wpm typing with a high level of accuracy.
Ability to work regularly scheduled shifts within hours of operation 
Your Duties:
  • Assign new participants to the Service Coordination team following established policies and procedures
  • Maintain appropriate records, files, and documentation
  • Distribute emails and faxes to providers
  • Enter new and modifications to authorizations into systems
  • Perform tasks necessary to promote participant compliance such as verifying appointments, obtaining lab results
  • Assess and monitor inpatient census
  • Screen for eligibility and benefits
  • Screen members by priority for assessment and refer to appropriate team following established workflows
  • Coordinate services with community based organizations
  • Attend marketing and outreach meetings as directed to represent the plan
  • Produce and mail routine letters and program educational materials
  • Provide support through inbound and outbound calls
  • Triage, adjust, or escalate requests to management
CareNational Healthcare Services
623.201.8732 (CALL – TEXT – FAX)
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