The Care Coordinator will serve as a vital clinical resource for members, guiding screenings, preventive measures, and benefit coverage. This role involves direct interaction with members and providers, ensuring timely and accurate support and documentation. The Care Coordinator will also participate in creating educational materials and marketing initiatives for healthcare awareness.

Job Responsibilities

• Serve as a clinical resource for members seeking guidance on screenings or other preventive measures to optimize overall health for members and their families.
• Provide clinical support to the Support team, handling live member calls, emails, and chats for members seeking clinical assistance during their use of the program.
• Lead the internal review of client plan documents, preparing benefit coverage summaries for the Provider Relations and Support team to answer members’ questions.
• Provide notice of coverage documentation outlining specific protocols for certain specialties (e.g., physical therapy, chiropractic visits, oncology, bariatric procedures).
• Serve as a clinical point of contact for providers with clinical coverage questions regarding treatment options, second opinion options, and alternative treatment plans.
• Follow up with pending items, ensuring members are updated promptly and responsively.
• Adhere to documentation standards to ensure all provider support and member support questions are properly logged and documented for client reviews, analytical reviews, and legal purposes.
• Initiate and oversee the creation of infographics and other marketing materials for key healthcare awareness months (e.g., Breast Cancer Awareness, Colon Cancer Awareness, Diabetes Education, Menopause).
• Proactively provide ideas on how to market or serve our member base more effectively.
• Become proficient in the client’s program knowledge to provide the highest level of support and service to members.
• Work on special projects deemed key by management or at the suggestion of staff, collaborating with management on project priorities as needed.

• Perform other miscellaneous office duties as needed.

Requirements

• Proven experience as a Care Coordinator, Case Manager, or similar role in a healthcare setting.
• Strong clinical background with knowledge of preventive healthcare measures and treatment options.
• Excellent communication skills, both written and verbal.
• Proficiency in handling member and provider inquiries via phone, email, and chat.
• Strong organizational skills and attention to detail.
• Ability to work independently in a remote setting.
• Proficiency with healthcare documentation standards and legal requirements.

Preferred Qualifications

• Bachelor’s degree in Nursing, Health Administration, or a related field.
• Experience with healthcare plan documentation and benefit coverage.
• Familiarity with creating educational and marketing materials for healthcare awareness.
• HIPAA Certification or training
• USRN Certificate
• Active NCLEX license

Minimum Technical and Work Environment Requirements:

• Internet Connection:
• Primary internet connection with a minimum speed of 15 Mbps.
• Backup internet connection with at least 10 Mbps.
• Backup connection must be capable of supporting work during a power outage.

• Primary Device:
• Desktop or laptop equipped with at least:
• Intel Core i5 (8th generation or newer), Intel Core i3 (10th generation or newer), AMD Ryzen 5, or an equivalent processor.
• A minimum of 8 GB RAM.

• Backup Device:
• Must meet or exceed the performance of an Intel Core i3 processor.
• Must be functional during power interruptions.

• A functioning webcam.
• A noise-canceling USB headset.
• A quiet, dedicated home office space.
• Peripherals and Workspace: A smartphone for communication and verification purposes.

Benefits

• Join Our Dynamic Team: Experience our fun, inclusive, innovative culture that values your unique contributions and supports your professional growth.
• Embrace the Opportunities: Seize daily chances to learn, innovate, and excel. Make a real impact in your field.
• Limitless Career Growth: Unlock a world of possibilities and resources to propel your career forward.
• Fast-Paced Thrills: Thrive in a high-energy, engaging atmosphere. Embrace challenges and reap stimulating rewards.
• Flexibility, Your Way: Embrace the freedom to work from home or any location of your choice. Create your ideal work environment.
• Work-Life Balance at Its Best: Say goodbye to stressful commutes and hello to quality time with loved ones. Achieve a healthy work-life integration to perform at your best.