program coordinator 1.

Screen members by priority for case management (CM) assessment.
Perform transition of care duties to include but not limited to, contact the member?s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs.
Coordinate services with community based organizations.
Attend marketing and outreach meetings as directed to represent the plan.
Produces and mails routine CM letters and program educational material.
Initiate authorization requests for output or input services in keeping with the prior authorization list.
Research claims inquiry specific to the department and responsibility.
Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results.
Assess and monitor inpatient census. Screen for eligibility and benefits.
Identify members without a PCP and refer to Member Services.
Screen members by priority for case management (CM) assessment.
Perform transition of care duties to include but not limited to, contact the member'ss attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations.
Attend marketing and outreach meetings as directed to represent the plan.
Produces and mails routine CM letters and program educational material.
Data enter assessments and authorizations into the system.

Working hours: 8:00 AM - 5:00 PM

Skills:
Thorough knowledge of customer service.
Utilization review or claims processing practices in a managed care environment
Operation of office equipment such as a personal computer.
Knowledge of medical terminology.

Education:
High School

Experience:
1-4 years

Qualifications:
High school diploma or equivalent.
2-3 years managed care or physician's office experience.
Need be flexible for mandatory OT
Remote from McAllen
Data entry assessments and authorizations into the system.


Apply online www.spherion.com/apply and then, call us at 956-961-4298

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. No one works harder for you than Spherion. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).

For certain assignments, Covid-19 vaccination and/or testing may be required by Spherion's client or applicable federal mandate, subject to approved medical or religious accommodations. Carefully review the job posting for details on vaccine/testing requirements or ask your Spherion representative for more information.