Managed Care Coordinator Horizon Blue Cross Blue Shield of New Jersey 502 reviews - Mount Laurel, NJ This position supports the Health Services and Utilization Management functions and acts as a liaison between members, physicians, delegates, operational business members and member service coordinators. Responsibilities * Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients. * Handles initial screening for precertification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff. * Prepare, document and route cases in appropriate system for clinical review. * Initiates call backs and correspondence to members and providers to coordinate and clarify benefits and courses of treatment. * Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion. * Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening. * Non Clinical staff are not responsible for conducting any UM review activities that require interpretation of clinical information. * Collect and collate information required to handle escalated phone/correspondence inquiries. * Assist with on-boarding and training of new Managed Care Coordinators. * Perform other relevant tasks as assigned by management. Specialized knowledge/skills * Requires knowledge of medical terminology. * Requires good oral and written communication skills. * Requires ability to make sound decisions under the direction of Supervisor. * Prefer knowledge of contracts, enrollment, billing & claims coding/processing. * Prefer knowledge Managed Care principles. * Prefer the ability to analyze and resolve problems with minimal supervision. * Prefer the ability to use a personal computer and applicable software and systems. * Team Player, Strong Analytical, Interpersonal Skills. Education/Experience * High School Diploma required. Some College preferred. * Prefer 3-5 years customer service experience. Travel * May require some travel. Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. 17 hours ago - save job - original job Apply On Company Site Other jobs you may like Point of Care Testing Coordinator - Pathology... University of Pennsylvania Health System Philadelphia, PA 6 days ago Manager, Practice Transformation and Care Coo... Philadelphia College of Osteopathic Medicine Philadelphia, PA 18 days ago Customer Care Coordinator Full-Time TruGreen Philadelphia, PA 2 days ago Easily apply Care Coordinator: Philadelphia CleanSlate Philadelphia, PA 1 day ago Health Care Coordinator City of Philadelphia Philadelphia, PA 9 days ago * Managed Care Coordinator jobs in Mount Laurel, NJ * Managed Care Coordinator salaries in Mount Laurel, NJ Horizon Blue Cross Blue Shield of New Jersey Horizon Blue Cross Blue Shield of New Jersey 502 reviews Led by Chairman, President and CEO, Kevin P. Conlin, Horizon Blue Cross Blue Shield of New Jersey is the states largest and leading health... Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume