Associate Care Management Coordinator (Healthcare)

TL;DR

Associate Care Management Coordinator (Healthcare): Processing pre-certification requests for medical services and routing cases to nurse reviewers with an accent on regulatory compliance and medical necessity determination. Focus on maintaining high call center standards, accurate documentation, and coordinating between providers and internal staff.

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

Company

hirify.global is a leading healthcare organization providing health insurance and integrated care services.

What you will do

• Process pre-certification requests for medically necessary healthcare services in compliance with organizational and regulatory policies.
• Route cases to nurse reviewers and other departments based on clinical information and decision timeframes.
• Communicate effectively with Utilization Management staff, providers, and external customers.
• Manage high call volumes and response times to meet or exceed department production and quality standards.
• Request and document additional clinical information from providers when necessary to make medical necessity determinations.

Requirements

• High School Diploma or GED.
• Experience in customer service, typing, and general computer skills.
• Work experience with medical terminology.
• Associates degree or certification in a health-related occupation.
• Work experience with ICD-9 and/or CPT coding.
• Must be based in Delaware for the "Working at Home" arrangement.