Care Management Coordinator (Healthcare)

TL;DR

Care Management Coordinator (Healthcare): Processing pre-certification requests for medically necessary health care services with an accent on clinical documentation and regulatory compliance. Focus on routing service requests to nurse reviewers and maintaining department standards for response time and quality.

Location: Remote (Must be based in Delaware, US)

Company

hirify.global is a leading health insurance and healthcare provider organization.

What you will do

• Process pre-certification requests for authorization of medically necessary health care services.
• Route service requests to nurse reviewers and other departments based on documentation procedures and decision timeframes.
• Communicate effectively with Utilization Management staff, providers, and external customers.
• Request additional information verbally and in writing when documentation is inadequate for medical necessity determination.
• Escalate cases requiring clinical review or other intervention to leadership.
• Maintain or exceed department standards for call volume, response time, and quality measures.

Requirements

• Must be based in Delaware, US.
• 3 years of experience in customer service.
• 3 years of work experience in medical terminology.
• 3 years of experience in typing, keyboard, and computer skills.
• High School diploma or GED.

Nice to have

• Associates degree or certification in a health-related occupation.
• Work experience with ICD-9 and/or CPT coding.

Culture & Benefits

• Fully remote work-from-home arrangement.
• Commitment to equal opportunity and accessibility for all applicants.
• Professional environment adhering to high ethical and legal standards.