Patient Management Coordinator jobs in Maine

Nurseline is the first point of contact in helping our members navigate the increasingly complex healthcare system, responsible for fielding calls regarding upcoming medical procedures, addressing general medical questions, and referring members to our Case Management, Disease Management, and Wellness programs.

Key Responsibilities

As Nurseline Coordinator you will be responsible for:

· Serving as an advocate for members navigating the healthcare system;

· Assisting Nurse Case Managers in coordinating care at Boston-based Centers of Excellence (COEs) and select value-based pricing (VBP) locations;

· Fielding calls from medical providers regarding pre-notification for upcoming procedures;

· Obtaining clinical information from members related to inpatient admissions;

· Performing follow-up calls to members after surgeries, imaging, and select outpatient procedures to help ensure health outcomes and continuity of care;

· Coordinating bi-annual Saturday mammogram program;

· Working with Pharmacy Benefit Managers (PBMs) on denials, overrides, and day-to-day issue resolution;

· Entering pre-notifications from members, providers, and healthcare facilities into internal systems;

· Providing information about treatments, alternatives, and educational materials to members and members’ families, as needed;

· Communicating plan benefits and limitations in coordination with Customer Service;

· Assisting in performing medical necessity reviews;

· Maintaining accurate and current documentation of all activities in internal systems;

· Adhering to and abiding by HIPAA standards and safeguarding PHI.

Qualifications & Experience

· Medical Assistant, Pharmacy Tech, Medical Secretary or License Practical Nurse with at least three (3) years’ experience;

· Knowledge of insurance and pharmacy benefits;

· Ability to perform critical analysis, solve problems, and prioritize & coordinate time-sensitive initiatives;

· Strong written and verbal communication skills;

· Proficient understanding of Microsoft Office software;

· Knowledge of ICD-10, HCPC, and CPT codes, UB’s, and EOB’s

Job Type: Full-time

Pay: $21.84 - $28.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Gray, ME 04039 (Required)

Ability to Relocate:

• Gray, ME 04039: Relocate before starting work (Required)

Work Location: Hybrid remote in Gray, ME 04039