Managed Care Coordinator II (Bilingual - Spanish Speaking)

This role supports Clinical Operations at Horizon Blue Cross Blue Shield of New Jersey, acting as a liaison between members, providers, and internal teams. It involves reviewing service requests, coordinating benefits, and assisting with case management, primarily for health insurance members.

Location: New Jersey, USA

Salary: $50,100 - $67,095

Responsibilities

• Review service requests for completeness and data collection.
• Prepare and route cases for clinical review.
• Coordinate benefits and treatment courses with members and providers.
• Handle escalated inquiries and investigations.
• Assist with onboarding and training of new staff.
• Act as liaison with providers, members, and Care Managers.
• Perform other tasks as assigned.
• Perform initial screening of precertification requests using established scripts.
• Assist members with provider finding, problem resolution, and appointment scheduling.
• Review claims and address gaps in preventative care.
• Educate members on health activities and services.
• Triage and distribute referrals from Member Services.

Requirements

• High School Diploma/GED.
• 3-5 years customer service experience preferred.
• Knowledge of medical terminology.
• Good oral and written communication skills.
• Ability to make sound decisions under supervision.
• Knowledge of managed care principles (preferred).

Benefits

• Comprehensive health benefits (Medical/Dental/Vision).
• Retirement Plans.
• Generous PTO.
• Incentive Plans.
• Wellness Programs.
• Paid Volunteer Time Off.
• Tuition Reimbursement.

Additional Information

• Position may require working one holiday shift per year for Behavioral Health.
• For Letters Team: review documentation for accuracy and compliance.
• Medically Certified Spanish Translators: translate and review documents in English and Spanish.
• Employees must reside in NJ, NY, PA, CT, or DE.
• Horizon is an Equal Opportunity Employer.