The Medical Management Care Coordinator collects specific data in the medical management information system for the clinical staff while also resolving authorization issues as well as troubleshooting, researching and resolving related issues in a timely and efficient manner.
Obtains information from doctors and/or providers and enters data into the medical management information system to enable clinical staff to correctly apply assessment tools
Creates case files for services that require authorization and maintains accurate data in all applicable systems to ensure prompt decision-making and accurate claims adjudication
Delivers strong customer service and problem solving while providing triage and management of calls with accuracy of data collection and ensuring established call performance targets are consistently achieved
Tracks and monitors customer complaints concerning service requests. Reports any unusual or complex issues/trends to management; recommends corrective actions
Provides triage and management of calls ensuring that established call performance targets are consistently achieved
Education: High School degree or equivalent required.
Experience: Minimum of two years of experience in a customer service role required. Excellent oral and written communication skills required. Advanced personal computer skills, including Word, Excel or Access required. Utilization Management experience preferred.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.