Pediatric Medical Care Coordinator
About the Role
Priority Health is looking for a Pediatric Medical Care Coordinator to join our team! The Pediatric Medical Care Coordinator serves as a key resource for members and families, providing care coordination, education, and support related to medical conditions, benefits, and coverage. This role helps members navigate complex healthcare systems, overcome barriers to care, and connect with appropriate resources and services. Working under the supervision of a licensed Care Manager, the coordinator supports members with chronic conditions or rising health risks through outreach, education, and reinforcement of care plans.
Responsibilities
- 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 member's 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 member's 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.
- Manages 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 LPN
- 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 top-notch 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.
- On-demand 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
- Traditional and Roth retirement options with service contribution and match savings