Member Care Coordinator 30189
Location: Albuquerque
Posted on: June 23, 2025
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Job Description:
One of the largest health insurers in the nation is focused on
continuously building an industry-defining, world-class IT
capability. Healthcare is forever evolving, especially due to
emerging technologies, making this a great experience to add to
your resume. Come join their winning team! This contract to hire
role as a Member Care Coordinator in Albuquerque, NM is responsible
for conducting home health assessment, contacting identified
members to inform and educate them on health care programs to
address their personal health plan needs, engaging the member in
discussion of adherence to personal health plans, responding to
inquiries from members, and supporting the clinicians in the
Medical Management department with their provider and member
activities. Pay Rate: $28 - $30 per hour Responsibilities: •
Responsible for home health assessments and system updates. •
Perform outreach and follow up attempts to members on their health
care plan. • Build relationships with members to encourage
compliance with care plans and to alert the Case Manager quickly
when issues arise. • Inform and educate members on their program,
may use supplied scripts. Complete records in system by performing
data entry. Encourage member usage of our programs, including
arranging appointments and additional member services (e.g.,
transportation). Generate appropriate correspondence and send to
member manually, electronically, or telephonically. • Conduct
check-ins with members to review individual care plan goals. •
Maintain production requirements based on established department
business needs. • Provide support to the clinical team by
performing the non-clinical functions (as identified by the
business process) necessary to generate, manage, and close a case
within the platform. • Receive, analyze, conduct research and
respond to telephone and/or written inquiries. Process information
from member or provider to determine needs/wants and ensure
customer questions have been addressed. Respond to customer or send
to appropriate internal party. • Notify help desk of system issues.
• Perform data entry function to update customer or provider
information. • Obtain required or missing information via
correspondence or telephone. • May serve as contact for the various
groups regarding claims which involves conducting research,
obtaining medical records/letters of medical necessity from TMG,
reopen or initiate new cases as needed and refer case to
clinicians. • Support and maintain communications with various
in-house areas regarding groups? concerns, i.e.: Marketing,
Provider Affairs, and SSD. • Communicate and interact effectively
and professionally with co-workers, management, customers, etc. •
Comply with HIPAA, Diversity Principles, Corporate Integrity,
Compliance Program policies and other applicable corporate and
departmental policies. • Maintain complete confidentiality of
company business. • Maintain communication with management
regarding development within areas of assigned responsibilities and
perform special projects as required or requested. Job
Requirements: ? • Bachelor of Social Work or Psychology OR LVN, LPN
with 1 year experience in managed care systems OR RN OR 3 years
care coordination for a state managed or waiver program OR 3 years
managed care systems experience. • Knowledge of medical terminology
• Experience coordinating member medical related needs, providing
assistance to members, and analyzing member needs • PC proficiency
including Microsoft Office applications • Customer service skills •
Verbal and written communications skills including developing
written correspondence to members and to other department personnel
and coaching skills, including motivational interviewing, to
educate members on medical issues. • Current state driver license,
transportation, and applicable insurance. • Ability and willingness
to travel Benefits : Solving IT, a Woman and LGBTQ owned and
operated organization is thrilled to provide a comprehensive
benefit package to all our W2 employees and their families,
regardless of gender. We are proud to offer five diverse health
plan options as well as a PPO dental plan through Blue Cross Blue
Shield, Term Life/AD&D Insurance, and a 401(k) Savings Plan.
Solving IT covers a portion of the health and dental premiums for
our employees. As you progress in your professional journey,
Solving IT is dedicated to accommodating your evolving preferences
and matching you with fulfilling projects. We champion equality and
embrace diversity in all its forms. Creating an atmosphere that
encourages varied perspectives to collaborate fosters personal
development, strengthens team unity, and contributes to the overall
success of the organization! Whether you're seeking your next
career challenge or aiming to stay abreast of industry trends,
Solving IT is committed to supporting your career advancement. We
actively encourage applications from all backgrounds and utilize
the most up-to-date market insights and compensation data to ensure
that you receive not just advice, but the complete Solving IT
Experience.
Keywords: , Rio Rancho , Member Care Coordinator 30189, Healthcare , Albuquerque, New Mexico
