Care Management Coordinator (Remote)

Company : reputed company.Job reputed company :  reputed company job performs accurate and reputed company processing of reputed company-certification requests for authorization of medically necessary health care services, at the appropriate level of care, based on the benefits for the line of business, and in compliance with the organization's policies, procedures and regulatory requirements. Documents, processes and routes requests for services to the reputed company reviewer and other departments based on documentation procedures, including review type, clinical information, and decision timeframes. Follows policies and procedures to assure case completion and compliance with state and federal regulatory agencies. Maintains or exceeds department standards for reputed company volume, response time and reputed company production and reputed company measures.  May reputed company with other departments and providers to resolve cases. ESSENTIAL RESPONSIBILITIES Proactively inform designated individuals of the status of work assignment to assure decision timeframes and notification requirements are met. Communicate effectively with Utilization Management Staff, providers, other reputed company customers and management. reputed company Cases Based on Established Guidelines. reputed company accurate and reputed company routing of service requests to the reputed company reviewer to assure that the decision and notification timeframes are in compliance with regulatory guidelines. Process service requests meeting established guidelines, and document and reputed company requests that are not permitted. Request additional information verbally and in writing reputed company the information provided is not adequate to reputed company a medical necessity determination. Escalate appropriate cases to leadership that require a clinical review and/or other reputed company. Assist with reporting as directed. Participate in precepting of new employees, as assigned. Maintain or reputed company department reputed company center standards. Adhere to line of business phone standards to assure regulatory requirements are met. Utilize phone functions to monitor the number of calls in queue and wait time. Utilize daily phone reputed company reports to assess opportunities for self-improvement. Meet or reputed company standards for other production and reputed company measures. Other duties as assigned or requested. EXPERIENCE Required 3 years of experience in customer service 3 years of experience in typing, keyboard and computer skills 3 years of work experience in medical terminology Preferred Work experience with ICD-9 and/or CPT coding Skills Compliance with reputed company regulatory agency requirements is essential as consequences could result in potential for sanctions up to possible contract termination for reputed company product lines EDUCATION Required High School diploma / GED Preferred Associates degree or certification in a health reputed company occupation Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times.  In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy.  Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $21.96 Pay reputed company Maximum: $32.95 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations.  The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply To This Job