Medical Care Coordinator

Corewell Health • Grand Rapids, MI

3d • Onsite

About The Position

A healthcare professional with a customer-centric focus to coordinate, outreach to, and respond to members regarding issues and questions related to medical conditions, benefits, and coverage criteria. This role involves navigating members through complex systems by working across the health plan and care network to ensure members receive and understand their care options. The coordinator will guide members through Priority Health networks, internal and external medical resources, policies, and procedures. They will act proactively on the member's behalf with routine benefits, gaps in care, and prior authorization processes. Additionally, the role involves working directly with members identified with rising risk, under the supervision of a licensed Care Manager, to provide delegated tasks for disease-specific education for both adult and pediatric populations and reinforcement of the treatment plan.

Requirements

• Associate's Degree with a health care focus or LPN
• Skills/knowledge/abilities typically gained through less than 2 years of related work experience in a clinical office or health insurance setting.
• 3 years of relevant experience Working in an organization of size and complexity comparable to Spectrum Health or managed care organization.

Nice To Haves

• 5 years of relevant experience Related work in a clinical office or health insurance setting.

Responsibilities

• Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.
• Assesses and identifies the needs and evaluates to determine if the member needs complex care management. If the needs are not complex, assists the member to meet their health care needs.
• Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
• Acts proactively on member’s behalf with routine benefits, gaps in care and prior authorization processes.
• Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.
• Identifies barriers and social determinants of health and assists to address or eliminate these barriers.
• Manages members with stable but complex conditions or rising risk related to chronic conditions.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree