Medical Care Coordinator
| Company | Corewell Health |
|---|---|
| Location | Grand Rapids, MI, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s, Master’s |
| Experience Level | Mid Level, Senior |
Requirements
- Michigan Licensed Bachelors prepared social worker or Limited License Masters prepared social worker or Limited License Bachelors prepared social worker.
- 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 Corewell Health or managed care organization.
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.
- Is the member’s first point of contact into Care Management. 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 a caseload up to 450 members with stable but complex conditions or rising risk related to chronic conditions.
Preferred Qualifications
- 5 years of relevant experience Related work in a clinical office or health insurance setting