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Brighton Health Plan Solutions · 22 hours ago

Care Coordinator -Workers Compensation

United States

Full-time

Remote

Entry Level

1+ years exp

Brighton Health Plan Solutions is a healthcare enablement company committed to transforming the health plan experience. The Care Coordinator will facilitate care management and utilization review for workers' compensation cases, ensuring effective communication with all stakeholders involved in the process.

AdviceHealth CareHospital

Growth Opportunities

Hiring Manager

Paul Pascale

Responsibilities

Collect data from claimant representative, physician, or hospital; verify claimant case status and provider network status

Set up cases in system in accordance with departmental workflows, policies and procedures

Assist Nurse Case Reviewers with non-clinical issues tasks such as requesting clinical information from providers, obtaining necessary forms, and confirming work status

Enter required case demographics and transcribe clinical information

Handle incoming group phone calls and interact with employers, employees, physicians and insurance adjusters to gather information about medical status, and/or type of care needed in a timely manner

Schedule medical appointments for members with in-network facilities and providers and coordinate/verify member attendance at the appointment

Maintain and update all activity trackers within designated timeframes

Verify and ensure the accuracy of claimant cases; create, scan, fax, mail, and upload correspondence and documentation as needed

Follow established quality assurance standards and all policies and procedures

Report and document any concerns, complaints and/or issues with direct supervisor

Demonstrates a kind, caring, sympathetic and positive attitude with all customers and fellow employees

Perform Ad-Hoc projects and support departmental initiatives as needed

Qualification

Workers' Compensation knowledgeMedical record reviewData collectionExcel proficiencyCase management experienceBilingualProfessional demeanorOrganizational skillsCommunication skillsTeam player