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Program Coordinator II

Eugene, Oregon Apply Now Job ID 1149551 Category Health Insurance Operations Organization Trillium Community Health Plan Schedule Full-time
Description:
Position Purpose: Perform duties to assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.

  • Initiate authorization requests for output or input services in keeping with the prior authorization list. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to the department and responsibility. Attend ongoing training and inservices as directed. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census.
  • Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Answers phone queues and faxes within established standards. Screen members by priority for CM assessment.
  • Coordinates services with community based organizations. Attends marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Helps develop marketing and outreach meetings as directed to represent the health plan.
  • Train new Program Coordinators on system and usage. Guide staff regarding benefits, authorization requirements and policy and procedure.
  • Data enters assessments and authorizations into the system. Maintains database as directed.
  • Qualifications:

    Education/Experience: High school diploma or equivalent; 3-5 years managed care or physician’s office experience. Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.

    Licenses/Certifications: LPN license highly preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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