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    Medicare Medical Care Coordinator - Grand Rapids, United States - Corewell Health

    Corewell Health
    Corewell Health Grand Rapids, United States

    3 weeks ago

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    Description


    Job SummaryA healthcare professional with a customer centric focus to coordinate, outreach to and respond to members regarding issues and questions related to medical conditions, benefits and coverage criteria.

    1)


    Navigate members through our complex systems by working across the health plan and care network to ensure members receive and understand their care options.

    2) Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc. 3) Act proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. 4.) 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.

    Essential Functions+ 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 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 + 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 RequiredPhysical Demands+ Pallet to Waist (6" from floor) > 5 lbs:

    Seldom up to 25 lbs+ Waist to Waist > 5 lbs: Seldom up to 25 lbs+ Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs+ Waist to Overhead > 5 lbs: Seldom up to 5 lbs+ Bilateral Carry > 5 lbs: Seldom up to 25 lbs+ Unilateral Carry > 5 lbs: Seldom up to 10 lbs+ Pushing Force > 5 lbs: Seldom up to 20 lbs+ Pulling Force > 5 lbs: Seldom up to 15 lbs+ Sitting: Occasionally+ Standing: Occasionally+ Walking: Occasionally+ Forward Bend - Standing: Seldom+ Forward Bend - Sitting: Seldom+ Trunk Rotation - Standing: Seldom+ Trunk Rotation - Sitting: Seldom+ Squat: Seldom+

    Stair Climbing:
    Seldom+ Crawling / Kneeling: Seldom+ Reach - Above Shoulder: Seldom+ Reach - at Shoulder or Below: Seldom+ Handling: Occasionally+ Forceful Grip > 5 lbs: Seldom+ Forceful Pinch > 2 lbs: Seldom+ Finger/

    Hand Dexterity:
    Frequently+ Visual Acuity 1 [None = No; Seldom = Yes]: SeldomPrimary LocationSITE - Priority Health E Beltline - Grand RapidsDepartment NamePH - Care Management - MedicareEmployment TypeFull timeShiftDay (United States of America)

    Weekly Scheduled Hours40Hours of Work8:30 a.m. - 5:00 p.m.
    Days WorkedMonday
    • FridayWeekend FrequencyN/A CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account.
    This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community.

    We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.

    We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

    Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

    An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization.

    As a health system, we advocate for equity as we care for our patients, our communities, and each other.

    From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do.

    We invite those that share in our commitment to join our team.

    You may request assistance in completing the application process by calling People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency.

    Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members.

    Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.
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