Medical Care Coordinator

Corewell Health • Grand Rapids, MI

3d

About The Position

The Medical Care Coordinator is a customer-focused healthcare professional who coordinates outreach and responds to members’ questions and issues related to medical conditions, benefits, and coverage criteria. The role helps members navigate the health plan and care network, understand their care options, and access internal and external medical resources. The coordinator acts proactively on members’ behalf regarding routine benefits, gaps in care, and prior authorization processes.

Working under the supervision of a licensed Care Manager, the coordinator provides delegated disease-specific education and treatment-plan reinforcement to adults and pediatric members with rising or identified risk. The role also identifies barriers and social determinants of health, helps address them, and supports members with stable but complex or rising-risk chronic conditions. The coordinator assesses members’ needs and determines whether complex care management is appropriate; when needs are not complex, the coordinator assists members in meeting their healthcare needs.

Requirements

• Associate’s degree with a healthcare focus or LPN.
• Skills, knowledge, and abilities typically gained through less than two years of related work experience in a clinical office or health insurance setting.
• Three years of relevant experience working in an organization of size and complexity comparable to Spectrum Health or a managed care organization.

Nice To Haves

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

Responsibilities

• Navigate members through the health plan and care network so they receive and understand their care options.
• Assess and identify members’ needs and determine whether they require complex care management; assist members whose needs are not complex.
• Guide members through Priority Health networks, internal and external medical resources, policies, and procedures.
• Act proactively on members’ behalf regarding routine benefits, gaps in care, and prior authorization processes.
• Under the supervision of a licensed Care Manager, provide delegated disease-specific education and treatment-plan reinforcement to adult and pediatric members with rising or identified risk.
• Identify barriers and social determinants of health and assist in addressing or eliminating them.
• Manage members with stable but complex conditions or rising risk related to chronic conditions.

Benefits

• Comprehensive benefits package to support financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv.
• Discounts directory with deals on restaurants, phone plans, spas, and other items.
• Optional identity theft protection.
• Optional home and auto insurance.
• Traditional and Roth retirement options with service contribution and match savings.

What This Job Offers

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