ProgenyHealth is a leading provider of care management solutions for maternal and infant populations. We partner with health plans and their obstetric, perinatal, and neonatal providers to work collaboratively in developing a plan of care specific to the needs of each member/family – from prenatal care to delivery to admission to the intensive care nursery until they are safely transitioned from the hospital, up to the first year of an infant s life. Our program promotes appropriate utilization, improves access, educates members and their families, addresses social determinants of health, reduces costs, and improves outcomes.

Job Role:

The Care Coordinator (CC) works in a telephonic managed care setting supporting the Case Management (CM) department in the administration of CM non-clinical functions to include: telephonic outreach to members; monitoring member eligibility and appointment adherence; updating database information and researching support services for families. Care Coordination activities focus on connecting maternity and postpartum members to healthcare services and community resources in a collaborative effort to optimize the health of the mother and baby.

Job Responsibilities:

• Conducts outreach to members to provide an overview of ProgenyHealth s services and works to develop open communication with members and freely offers assistance in a friendly, helpful and courteous manner.
• Conducts initial outreach and follow-up calls during members pregnancy and/or postpartum.
• Provides information to members regarding client s benefits.
• Outreaches to member and PCP based on ProgenyHealth s CM policies and procedures.
• Assists with locating community resources.
• Demonstrates ongoing adherence monitoring of prenatal and/or well child visits.
• Completes follow up calls to PCP/OB provider and/ or Client when barriers for access to care are identified.
• Researches alternate demographic information for family and /or PCP/OB provider.
• Refers caregiver to Complex Case Management team in the event complex medical or social needs are identified.
• Maintains accuracy in update of database as necessary.
• Ensures eligibility and benefit verification prior to each outreach call as per ProgenyHealth policies and procedures.

Qualifications

• High School diploma or equivalent required. College degree preferred.
• 3 or more years of experience in customer service in a healthcare environment.
• A minimum of 1-year experience in Insurance/payor environment required.
• 2 years case management experience desired.
• Working knowledge of healthcare terminology.
• Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word.
• Must be well-organized and able to prioritize tasks.

Benefits/Culture

Some of the benefits we offer our team are:

• Paid Time Off
• Medical, dental, vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities
• Business Casual work environment
• Team oriented events throughout the year
• Role specific - partial or full remote work week

ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com

Job location:

• This position may be performed remotely – candidates outside of the Eastern PA area will be considered.