Job Details

Immediate need for a talented Care Management Support Coordinator II. This is a 03+months contract opportunity with long-term potential and is located in TX(REMOTE). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-72702

Pay Range: $18 - $18.50/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Hours: Full time - 40 hours per week
• Schedule: Monday to Friday, 8:00 am to 5:00 pm (Subject to change depending on business needs) / Possible overtime according to business needs.
• Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services.
• Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines
• Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service.
• Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service.
• May apply working knowledge of assigned health plan(s) activities and resources.
• Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols.
• Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship.
• Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed.
• Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs.
• Performs other duties as assigned.
• Complies with all policies and standards.
• The Centralized Authorization Team consists of the processing of authorizations for LTSS, in which we are now at a 3-4 BD TAT for the processing of LTSS/ SK/SH/MMP authorizations.
• We will utilize project temps/contingent workers to assist with each of these areas as well as cross train them to be able to assist in multiple functions.
• The authorization team continues to experience a high task and authorization volume as the number of VIP providers has increased.

Key Requirements and Technology Experience:

• Key Skills; 2 years of medical experience in authorizations or claims processing practices in managed care setting.
• Knowledge of medical terminologies
• Knowledge of customer service, medical terminology, and operation of office equipment.
• Excellent attendance (especially during training)
• Daily goal will start with 5 authorizations for start then will move to 19 gradually
• Daily production trackers must be completed and emailed to designated person at the end of your shift
• Multi-tasking with multiple monitors and applications
• Utilize work guides and or resources
• 97% Quality (Audits)
• 98% Production
• 0-5% Error Rate
• Welcome call with Supervisor
• (Client) University Training Courses
• Shadow mentor via zoom screen share
• High School Diploma or GED
• Microsoft Outlook, Skype for Business, Zoom, Microsoft Word, Microsoft Excel, SharePoint, Internet

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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