Jobs in New Mexico 2026 (Now Hiring) - Smart Auto Apply
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Member Care Coordinator
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Overview
Job Description
- Responsible for home health assessments and system updates.
- Perform outreach and follow up attempts to members on their health care plan.
- Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise.
- Inform and educate members on their program, may use supplied scripts.
- Complete records in system by performing data entry.
- Encourage member usage of our programs, including arranging appointments and additional member services (e.g., transportation).
- Generate appropriate correspondence and send to member manually, electronically, or telephonically.
- Conduct check-ins with members to review individual care plan goals.
- Maintain production requirements based on established department business needs.
- Provide support to the clinical team by performing the non-clinical functions (as identified by the business process) necessary to generate, manage, and close a case within the platform
- Receive, analyze, conduct research and respond to telephone and/or written inquiries. Process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Respond to customer or send to appropriate internal party.
- Notify help desk of system issues.
- Perform data entry function to update customer or provider information.
- Obtain required or missing information via correspondence or telephone.
- May serve as contact for the various groups regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopen or initiate new cases as needed and refer case to clinicians.
- Support and maintain communications with various in-house areas regarding groups? concerns, i.e.: Marketing, Provider Affairs, and SSD.
- Communicate and interact effectively and professionally with co-workers, management, customers, etc.15. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
- Bachelor of Social Work or Psychology OR LVN, LPN with 1 year experience in managed care systems
- OR RN OR 3 years care coordination for a state managed or waiver program OR 3 years managed care systems experience.
- Knowledge of medical terminology
- Experience coordinating member medical related needs, providing assistance to members, and analyzing member needs
- PC proficiency including Microsoft Office applications
- Customer service skills
- Verbal and written communications skills including developing written correspondence to members and to other department personnel and coaching skills, including motivational interviewing, to educate members on medical issues
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