Title: Program Coordinator I

Location: REMOTE - DE

Duration: 5* Months Contract *(Temp to hire)

Target Start Date (based on successful onboarding completion): 08/05/2024

Shift: 8:00 AM - 5:00 PM EST - Monday - Friday

Walk me through the day-to-day responsibilities of this the role and a description of the project:

• Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
• Removing prior authorizations and adding member outreach calls, appointment linkage, community resource connections, social determinants of health follow up, provider calls
• Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, and obtaining lab results. Assess and monitor inpatient census.
• Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, and other medical providers (home health agencies, equipment vendors) for information about special needs.
• Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material.
• Data enter assessments and authorizations into the system.

Describe the performance expectations/metrics for this individual and their team:

• Performance expectations/metrics is 40 calls per day reaching out to the members assigned to the Program Coordinator I. Metrics must be met weekly to meet the expectation that is set by the department.

Tell me about what their first day looks like:

• 4 to 6 weeks of training, and trainings with the hire manager and department for the role they are hired to do as a program coordinator.

Required Skills/Experience/Education:

• 2 years of RECENT Member Outreach (Outbound Calls) Experience in a Managed Care/Medical Office setting, with demonstration of medical administration duties. Thorough knowledge of customer service, utilization review, or claims processing practices in a managed care environment. Must comfortable working in a high volume/heavy call flow environment
• Strong Customer Service, Knowledge of Medicaid/Medicare, Medical Terminology, Basic computer skills, Strong Typing Skills 40 WPM, Strong Proficiency in Microsoft Office (Word, Excel, Outlook, TEAMS), Communication skills, Time Management, Multitasking skills & Organizational skills are a MUST
• High School Diploma or GED required.

Job Type: Contract

Pay: $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Outbound calling: 2 years (Required)
• Managed care / Healthcare: 2 years (Required)

Ability to Commute:

• Newark, DE (Required)

Work Location: Remote