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Medical Coordinator HCMU

Job Introduction

Coordinate all actions related to the acquisition of high cost medications. From the reception and evaluation of the pre-authorization request, as well as the procurement process and the timely delivery of the drug to the client. Guarantee an extraordinary customer experience, using their clinical knowledge to find the best options in an efficient way and with a high level of quality. The documentation of all the actions taken, the adequate follow-up with clients, providers and agents are an essential component of this function.

Role Responsibility

  • Provides an adequate case evaluation for members who require treatment with high cost medications.
  • Coordinates with the corresponding providers the treatments as part of the procurement process and follow up on medication delivery.
  • Guarantee the appropriate procurement process according to the SOP for the HCMU.
  • Following HCMU SOP, documents all conversations with providers and physicians, medical record reviews, phone calls pertaining to patient care to ensure information is available companywide.
  • Monitor next refill date and proactively request any pertinent information necessary for medication coordination.
  • Assist with the evaluation of PDOCMs and active identification of Reimbursement cases to steer them to direct payment.
  • Proficient utilization of the HCMU Tool available in CRM for interaction with customers, procurement and selection process.
  • Clear and consistent communication skill capable to builds rapport with Hospital, Physicians, and earns their trust and respect to facilitate the gathering of information and enhance the company image and the care of the patient.
  • Identification and escalation of potentially fraudulent activity identified at the time of the evaluation process.

The Ideal Candidate

  • Medical Graduated is required.
  • At least two years of experience in medical practice or health insurance.
  • Bilingual English/Spanish; Portuguese helpful with exceptional verbal and written communication skills.

Bupa

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