Medical Management Coordinator

Basking Ridge, NJ 07920

Posted: 08/27/2019 Industry: Clerical Job Number: 9104 Pay Rate: $52,000 - $54,000/yr. (DH)


Responsible position providing medical management services to the Association Claims case management.


  • Provide a high level of quality customer service

  • Monitor medical cost control processes and programs

  • Monitor vendor compliance with company requirements, as directed

  • Review files and invoices to evaluate appropriate levels of care and medical payments, as well as quality control of the medical aspects of claims management

  • Review files and invoices to evaluate compliance with applicable statutory and regulatory requirements, as well as industry best practices

  • Other tasks as requested or required including but not limited to:

  • Contacting claimant or attorney to provide information on case management and discuss appointment dates

  • Contacting physician(s) to confirm appointment times, address, etc.

  • Where applicable, contacting employer to discuss work status, determine light duty availability, etc.

  • Creating and sending appointment letters out

  • Requesting and exchanging medical records with the appropriate parties

  • Sending treatment form to be completed by provider and following up on completed report

  • Coordinating treatment recommendations by authorized treating provider with the claim s adjuster

  • Completing Medical Cost Projection and Estimated Length of Disability (consistent with ODG Guidelines) with provider

  • Coordinating approval of medications as prescribed the authorized provider


  • Bachelor's degree in nursing, or related field, or the equivalent in work experience

  • Licensed RN or LPN

  • Three to five years of progressively responsible positions in claims

  • Strong verbal and written communication skills

  • Ability to work effectively with staff and constituents

  • High degree of judgment

  • Knowledge of medical management practices and requirements, applicable claim procedures, statutes, compliance, insurance laws and insurance coverage

  • Ability to work independently

  • Strong organizational skills with ability to prioritize effectively and meet deadlines

  • Proficiency in Word and Excel

Send an email reminder to:

Share This Job:

Related Jobs:

Login to save this search and get notified of similar positions.