Care Management Coordinator I

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. HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match

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