Medical Management Coordinator - Managed Care
Work From Home / TeleCommute - Louisville, KY ONLY
** Position is 100% fully Remote / Work-From-Home for candidates located in Louisville, KY! **
*** This is a Full-Time, Benefits Available, CONTRACT assignment, expected to last around 5 months***
Medical Management Coordinator Job Summary:
Medical Management Coordinator Background:
- Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, quality improvement, medical review).
- Provides information regarding network providers or general program information when requested.
- May assist with complex cases.
- May act as liaison between Medical Management and/or Operations and internal departments. Maintains and updates tracking databases.
- Prepares reports and documents all actions.
- Responsibilities exclude any utilization review activities which require interpretation of clinical information.
- 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.
- At least 1 years’ experience in a medical office, hospital or health plan call center, or other healthcare support role with heavy computer & phone use.
- Strongly prefer 1 or more years at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
- Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
- Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
- Knowledge of health care delivery system, Medicaid/Medicare and related state programs is required.
- Advanced computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.