Care Management Coordinator II

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.
We are proud to say that for three years, HMA has been chosen as a 'Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, 'Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.
What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.
What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/
How YOU will make a Difference:
The Care Management Coordinator demonstrates the ability to independently assess and synthesize work inputs to determine the scope and function of the work to achieve the desired goal; works directly with project team leads to implement new functions; provides input for coordinating member support functions across the Care Team; assesses the needs of the business and forms recommendations in response to business growth. Care Management Coordinator provides ongoing operational support across the organization as needed.
What you will do:

• Consult and work with healthcare providers throughout the RGA network to coordinate care and review service denials
• Work independently to create provider and member-facing denial letters by crafting clear and concise sentences using medical director denial information, personal expertise, medical criteria, and nurse input and plan language
• Use autonomy to triage and analyze requests for Peer to Peer calls, disabled dependent determinations, medical travel benefit work and other member and provider needs to determine next steps and actions
• Provide direct member contact and coordination for care needs not limited to disabled dependents, medical travel, continuity of care, denials, P2P and appeals
• Work across departments and with external partners to coordinate care not limited to customer care, Care navigators, intake, utilization review, case management, medical claim review, appeals, COB, enrollment and compliance
• Assess barriers to a positive member experience and strive to bridge gaps
• Support and fill-in non-clinical duties as needed to support the function of the Care Team
• Track and ensure regulatory functions and tasks are completed
• Analyze data and create work queues (PowerBI, Excel expertise)
• participate in the writing and updating of PWIs to keep team function documentation updated

Knowledge, Experience, and Key Attributes needed for Success:

• Minimum of Associate's degree or equivalent experience required
• 4-7 years of minimum health plan, clinical or community health experience
• Ability to communicate complex ideas
• Ability to interpret reporting and set a plan of action
• Ability triage and prioritize work
• The ability to problem-solve and use critical thinking skills
• Excellent, internal and external client-facing verbal and written communication skills
• Proficiency with Microsoft Office applications (Outlook, Word, DOSS)
• Self-motivated and self-directed
• Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets

Compensation:
The base salary range for this position in the greater Seattle area is $29/hr - $37/hr and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. In addition, HMA provides a generous total rewards package for full-time employees that includes: seventeen (IC) days paid time off; eleven paid holidays, one paid personal and one paid volunteer day; company-subsidized medical, dental, vision, and prescription insurance; company-paid disability, life, and AD&D insurances; voluntary life insurances; HSA and FSA pre-tax programs; 401(k)-retirement plan with company match; wellness incentive and reimbursement; remote work and continuing education reimbursements; discount program; parental leave; and a charitable giving match. For more information about HMA, visit www.accesshma.com .
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
How we Support your Work, Life, and Wellness Goals
We offer a comprehensive total rewards package including: competitive pay; annual incentive; wellness programs; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym; life, AD&D, short and long-term disability insurances; an Employee Assistance Plan with additional mental health support; free parking and easy freeway access to I-405 and I-520; a stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; monthly events; paid volunteer hours and more!
HMA is primarily a remote workforce, requires a reliable internet connection, and provides all hardware. Some roles are required onsite 1-3 days per week/month while other roles are 100% remote.
A background screen prior to employment is required.
Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
HMA is an Equal Opportunity Employer