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Corporate Functions & Operations WellCare - Clinical Support Careers

Care Coordinator Job

Full Job Title: Care Coordinator

Job Number: 1805064

Location: Oahu, HI

Date Posted: 2018-08-30

Evaluates the pre-service authorization request for Durable Medical Equipment, Orthotic and Prosthetics. Performs a unique role in reviewing records, uses subject matter expertise and compares information to established guidelines and the members benefit plan. Works closely with departmental clinical staff and management staff to impact the treatment plan and identify treatment plan alternatives.

Reports to: Mgr.Care Coordination

Department: HS- Outpatient Services

Location: Kapolei, HI.

Essential Functions:

  • Utilizes Well Care guidelines, CMS and State criteria, Fee Schedules along with subject matter knowledge to make authorization decisions and assist Medical Director with review determinations
  • Ensures accurate coding using most current coding guidelines. Documents all information accurately.
  • Corresponds and communicates with providers, vendors, members and various Wellcare departments.
  • Identifies and refers cases appropriate for case management.
  • Identifies potential quality of care issues and refers to Quality department.
  • Ability to follow and apply all necessary regulatory requirements for assigned market.
  • Assists with implementation of health care initiatives in market.
  • Assist in implementation of specific strategies of quality and outcomes of care.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred An Associate's Degree in a related field
    Candidate Experience:
    • Required 3 years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
    • Preferred Other For FL MLTC, 2 years experience in managed long term care and/or coordination of benefits for dual eligible members
    Candidate Skills:
    • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-10 coding
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to multi-task
    • Intermediate Other Work effectively within group to achieve desired outcomes
    • Intermediate Demonstrated interpersonal/verbal communication skills
    Technical Skills:
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft Word

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      Last Updated On: 12/9/2015