Program Coordinator

Program Coordinator

Company: Superior HealthPlan

Job Type: Full-Time

Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team at Superior HealthPlan. This role involves assisting in activities related to the medical and psychosocial aspects of utilization and coordinated care.

Responsibilities

• Initiate authorization requests for output or input services in keeping with the prior authorization list.
• Research claims inquiry specific to the department and responsibility.
• Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results and assessing and monitoring 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 including contacting the member's attending physician, member or medical power of attorney, and other medical providers for special needs information.
• Coordinate services with community-based organizations and attend marketing and outreach meetings as directed to represent the plan.
• Produce and mail routine CM letters and program educational material, as well as data enter assessments and authorizations into the system.

Education/Experience

High school diploma or equivalent. 2-3 years managed care setting, medical office, or facility setting with a demonstration of medical administration duties. Thorough knowledge of customer service, utilization review, or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.

Pay Range

$18.27 - $31.10 per hour.

Benefits

• Flexible work solutions including remote options, hybrid work schedules, and dress flexibility.
• Competitive pay.
• Paid time off including holidays.
• Health insurance coverage for you and your dependents.
• 401(k) and stock purchase plans.
• Tuition reimbursement and best-in-class training and development.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.