Care Coordinator

Role Overview

• Serve as a clinical resource for members seeking guidance on screenings or other preventive measures to optimize overall health for members and their families.
• Provide clinical support to the Support team, handling live member calls, emails, and chats for members seeking clinical assistance during their use of the program.
• Lead the internal review of client plan documents, preparing benefit coverage summaries for the Provider Relations and Support team to answer members’ questions.
• Provide notice of coverage documentation outlining specific protocols for certain specialties (e.g., physical therapy, chiropractic visits, oncology, bariatric procedures).
• Serve as a clinical point of contact for providers with clinical coverage questions regarding treatment options, second opinion options, and alternative treatment plans.
• Follow up with pending items, ensuring members are updated promptly and responsively.
• Adhere to documentation standards to ensure all provider support and member support questions are properly logged and documented for client reviews, analytical reviews, and legal purposes.
• Initiate and oversee the creation of infographics and other marketing materials for key healthcare awareness months (e.g., Breast Cancer Awareness, Colon Cancer Awareness, Diabetes Education, Menopause).
• Proactively provide ideas on how to market or serve our member base more effectively.
• Become proficient in the client’s program knowledge to provide the highest level of support and service to members.
• Work on special projects deemed key by management or at the suggestion of staff, collaborating with management on project priorities as needed.
• Perform other miscellaneous office duties as needed.

Requirements

• Proven experience as a Care Coordinator, Case Manager, or similar role in a healthcare setting.
• Strong clinical background with knowledge of preventive healthcare measures and treatment options.
• Excellent communication skills, both written and verbal.
• Proficiency in handling member and provider inquiries via phone, email, and chat.
• Strong organizational skills and attention to detail.
• Ability to work independently in a remote setting.
• Proficiency with healthcare documentation standards and legal requirements.

Preferred Qualifications

• Bachelor’s degree in Nursing, Health Administration, or a related field.
• Experience with healthcare plan documentation and benefit coverage.
• Familiarity with creating educational and marketing materials for healthcare awareness.
• HIPAA Certification or training
• USRN Certificate
• Active NCLEX license

Benefits

• Join Our Dynamic Team: Experience our fun, inclusive, innovative culture that values your unique contributions and supports your professional growth.
• Embrace the Opportunities: Seize daily chances to learn, innovate, and excel. Make a real impact in your field.
• Limitless Career Growth: Unlock a world of possibilities and resources to propel your career forward.
• Fast-Paced Thrills: Thrive in a high-energy, engaging atmosphere. Embrace challenges and reap stimulating rewards.
• Flexibility, Your Way: Embrace the freedom to work from home or any location of your choice. Create your ideal work environment.
• Work-Life Balance at Its Best: Say goodbye to stressful commutes and hello to quality time with loved ones. Achieve a healthy work-life integration to perform at your best.