Medical Management Coordinator - Managed Care
Work From Home / TeleCommute - Louisville, KY ONLY
  Medical Management Coordinator Job Summary:

• 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.

Medical Management Coordinator 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.
• 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.

 
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