Medical Care Coordinator

About the role

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. Primary Location: Priority Health, 1231 E Beltline Ave NE, Grand Rapids. Department: Care Management DSNP - PH Managed Benefits. Employment Type: Full time.

Responsibilities

• Navigate members through complex systems by working across the health plan and care network to ensure members receive and understand their care options.
• Guide members through Priority Health networks, internal and external medical resources, policies, procedures, etc.
• Act proactively on member’s behalf with routine benefits, gaps in care and prior authorization processes.
• Work 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 populations, and reinforcement of the treatment plan.
• Serve as the member’s first point of contact into Care Management.
• Assess and identify member needs and evaluate to determine if complex care management is required.
• If needs are not complex, assist the member to meet their health care needs.
• Identify barriers and social determinants of health and assist to address or eliminate these barriers.
• Manage a caseload of approximately 150‑300 members with stable but complex conditions or rising risk related to chronic conditions.

Qualifications

Required:

• Associate’s Degree with a health care focus, or 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 a managed care organization.

Preferred:

• 5 years of relevant experience.
• Related work in a clinical office or health insurance setting.

Benefits

• Comprehensive benefits package to meet financial, health, and work/life balance goals.
• On‑demand pay program powered by Payactiv.
• Discounts directory with deals on restaurants, phone plans, spas, and more.
• Optional identity theft protection, home and auto insurance.
• Traditional and Roth retirement options with service contribution and match savings.
• Eligibility for benefits is determined by employment type and status.

Schedule

Weekly Scheduled Hours: 40 hours (8:00 a.m. to 5:00 p.m.). Days Worked: Monday to Friday. Weekend Frequency: N/A.