We are seeking a driven individual with a passion for the healthcare industry. One of our clients is looking to add a strong Care Coordinator to their team. Responsibilities include:

1) Conduct care management coordination activities for managed care, employee assistance, and workers’ compensation beneficiaries system-wide

2) Tasks include scheduling and direct case management reviews, communication with hospitals, attending physicians, and outpatient providers

3) Conduct effectiveness reviews and monitoring functions to ensure quality assurance

4) Receive calls from patients, providers, and facilities

5) Arrange appropriate intake assessments and schedule referrals to the local case manager

6) Perform regular monitoring activities and provide coverage to the Clinical Services Division as needed

7) Explain benefits to employees, patients, and treatment providers.

8) Verify benefit eligibility and maintain effective communication with client company contacts

9) Participate in utilization review and quality assurance activities as directed

10) Coordinate utilization review activities with the internal physician review panel

11) Ensure ongoing and timely peer/clinical review of active inpatient and outpatient cases

12) Adhere to established internal clinical policies, procedures, and utilization review guideline

13) Review incoming claims for completeness of data and appropriate approval

14) Collaborate with data processing and the Accounting Division in the data analysis process

15) Provide after-hours coverage for emergencies on a shared basis

16) Collect data based on a structured intake questionnaire and arrange for peer review

17) Assist in the clinical coordination of patient activities and cases as requested

18) Maintain contact with members regarding the status of provider requests

19) Coordinate case reviews for medical necessity purposes.

20) Maintain a strong liaison with physician reviewers and the internal Medical Director

21) Maintain patient and departmental files, policies, procedures, and budgets

22) Assist in achieving annual goals, objectives, and divisional action plans

23) Perform other related duties as directed or deemed appropriate

24) Attend meetings as directed and maintain professional competency through continuing education, conferences, and internal training

Critical Requirements

1) A university degree is required. Although all candidates are welcome and encouraged to apply, preference will be given to those with degrees in a relevant field

2) Appropriate full-time work experience is mandatory (no students or fresh graduates please)

3) Recent experience in the healthcare industry is strongly preferred

4) Preference will be given to candidates with recent experience in clinical

If you are qualified and aspire to work for an excellent, established company whose employees believe in teamwork and make great contributions to the industry, then this could be a golden opportunity for you. Please apply ASAP!

Compensation and Other Details

Base Salary: Highly competitive package, commensurate with experience

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