Job Summary
Priority Health’s Medicaid Care Management Team is seeking a compassionate and dedicated Medical Care Coordinator with a strong passion for supporting individuals during the prenatal and postpartum periods. In this virtual role, the coordinator will proactively engage with pregnant and postpartum members to assess and support their care needs, ensuring timely access to resources and services. Ideal candidates will have experience working with maternal health populations and a commitment to improving outcomes for Medicaid members.
Essential Functions
Telephonically navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.
Is the member’s first point of contact into Care Management. Assesses and identifies the needs and evaluates to determine if the member needs complex care management. If the needs are not complex, assists the member to meet their health care needs.
Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
Acts proactively on member’s behalf with routine benefits, gaps in care and prior authorization processes.
Works directly with members with rising risk or identified with rising risk under supervision of a licensed Care Manager to provide delegated tasks for disease specific education for both adult and pediatric population, and reinforcement of the treatment plan.
Identifies barriers and social determinants of health and assists to address or eliminate these barriers.
Manages a caseload of approximately 150-300 members with stable but complex conditions or rising risk related to chronic conditions.
Qualifications
Required Associate’s Degree Associate’s Degree with a health care focus or LPN or Social work preferably with 2 years of experience in Maternal Health
Skills/knowledge/abilities typically gained through less than 2 years of related work experience in a clinical office or health insurance setting. Required
5 years of relevant experience Related work in a clinical office or health insurance setting Preferred
3 years of relevant experience Working in an organization of size and complexity comparable to Spectrum Health or managed care organization Required