Remote Nursing Jobs • Utilization Management

The Care Coordinator facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions and cost effective delivery of quality care and services across the continuum. They collaborate with the interdisciplinary care plan team to address care issues and specific member needs, whether medical, behavioral, social, community based or long term care services. This role coordinates the care of individual clients with identified populations.

Perform medical review to ensure correct dispositions according to all contracts, related endorsements, government regulations and BCBSNE medical policies. Responsible for accurate and timely medical review of claims and preauthorizations, as well as Customer Service inquiries. Determine availability of benefits according to company contracts, endorsements and medical policy.