Job Description

Medical Care Coordinator 

JOB-10044346

Anticipated Start Date

June 23, 2025

Location

Remote

Type of Employment

Contract Hire

Employer Info

Our client is a nationally recognized, not-for-profit health system. Supported by an exceptional team of dedicated professionals, including thousands of physicians, advanced practice providers, and nurses. They offer comprehensive services across numerous hospitals, outpatient locations, and post-acute facilities, all driven by an ambitious vision of continued advancement and excellence.

Job Summary

We are looking for individuals to join our client’s team as Medical Care Coordinator. 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.

Job Description

• Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
• Act 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
• 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.
• Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.
• Performs other duties as assigned.

Skills Required

• Required associate's degree with a health care focus or LPN. A Social Work or Register Nurse background. 

Education/Training/Certifications

• Required associate's degree with a health care focus or LPN

Additional Requirements

• Shift Time: 8a-5p

  Pay Rate

• $25.00 per hour

“We are an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law”.

Job Tags

Similar Jobs