Individual ACA Market Medical Care Coordinator
Individual ACA Market Medical Care Coordinator
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1 Vacancy
Job Description
Job Summary
A 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 members 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 members 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 members 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.
Qualifications
Required
Associates Degree with a clinical health care focus
Skills/knowledge/abilities typically gained through less than 2 years of related work experience in a clinical office or health insurance setting.
3 years of relevant experience Working in an organization of size and complexity comparable to Corewell Health or managed care organization
Preferred
5 years of relevant experience Related work in a clinical office or health insurance setting
About Corewell Health
As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our topnotch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
Ondemand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE Priority Health 1231 E Beltline Grand RapidsDepartment Name
PH Care Management IndividualEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8:00 a.m. to 5:00 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for NonCorewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drugfree workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an onsite 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 616.486.7447.
Required Experience:
IC
Employment Type
Full-Time
