Empower Healthcare Solutions

Care Coordinator

• Coordinate Managed Care Services: Oversee and facilitate the coordination of managed care services, including verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services.
• Deliver personalized health education and coaching to members based on identified concerns outlined in treatment and service plan.
• Provide member support access in addressing social determinants of health, such as facilitating access to exercise opportunities and nutritious food.
• Insurance Verification: Verify insurance coverage and benefits for patients, ensuring accurate and up-to-date information is obtained and documented.
• Conduct utilization reviews to evaluate the medical necessity and appropriateness of services.
• Collaborate with insurance companies and healthcare providers ensuring availability and quality of services.
• Facilitate coordination with diverse healthcare providers for diagnostics, ambulatory care, and hospital services.
• Member Advocacy: Serve as a point of contact for members, addressing their questions, concerns, and complaints related to managed care services, and advocating for their needs within the organization.
• Encourage initiatives aimed at improving the health of patients and their communities, including outreach efforts, quality improvement initiatives, and patient panel management.
• Coordinate community-based management of medication therapy.
• Compliance and Documentation: Ensure compliance with applicable laws, regulations, and contractual obligations related to managed care services.
• Maintain accurate and complete documentation of all interactions, authorizations, and communications.
• Continuous Improvement: Identify opportunities for process improvement and efficiency enhancement in managed care operations. Propose and implement strategies to optimize service delivery and enhance patient satisfaction.

Care Coordinator – Central DD