Managed Care Coordinator II (Bilingual – Spanish)

About This Opportunity

Our talent team is representing a confidential healthcare organization seeking a Managed Care Coordinator II (Bilingual - Spanish) to join their clinical operations team. This role serves as a critical liaison between members, physicians, and internal teams, requiring strong bilingual communication skills and healthcare knowledge.

Candidates will apply through Get A Job.ai, where our recruiters will conduct initial screenings before presenting qualified professionals to our client. Please do not attempt to contact the client directly.

Responsibilities

• Review service requests for completeness, collect non-clinical data, and obtain structured clinical information from physicians and patients
• Prepare, document, and route cases in appropriate systems for clinical review
• Initiate callbacks and correspondence to members and providers to coordinate benefits and verify treatment courses
• Handle escalated phone and correspondence inquiries by collecting and investigating required information
• Assist with onboarding and training newly hired Managed Care Coordinators
• Perform initial screening of precertification requests using established scripts and workflows
• Make outbound calls to engage members in case management and complete health assessments
• Review medical, dental, and vision claims to identify gaps in preventative care
• Educate members on preventive health activities and services
• Assist members with scheduling appointments, arranging transportation, and processing demographic changes
• Review medical and administrative documentation for accuracy, grammar, and regulatory compliance in both English and Spanish
• Translate clinical and non-clinical documents between English and Spanish with precise medical terminology
• Authorize services based on scripts or algorithms for pre-review screening
• Work one holiday shift per year as required

What We're Looking For

Required Qualifications:

• High School Diploma or GED
• 3-5 years of customer service experience
• Medical certification translator education (for specific letter review responsibilities)
• Knowledge of medical terminology
• Fluency in English and Spanish with strong oral and written communication skills in both languages
• Ability to make sound decisions under supervisor direction
• Strong analytical and interpersonal skills
• Team player with ability to work collaboratively
• Proficiency with personal computers and applicable software systems

Preferred Qualifications:

• Knowledge of contracts, enrollment, billing, and claims coding/processing
• Understanding of managed care principles
• Knowledge of clinical standards of care and quality measures
• Operational knowledge of healthcare delivery systems and health insurance industry
• Familiarity with NCQA accreditation standards and applicable state/federal laws
• Understanding of CMS and state regulatory requirements
• Ability to analyze and resolve problems with minimal supervision

Additional Requirements:

• Must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware
• Some travel may be required

How We Work With You

When you apply through Get A Job.ai, our recruiting team will review your qualifications and conduct an initial screening. If your background aligns with our client's needs, we will submit your profile for consideration. Throughout the process, we serve as your advocate and primary point of contact. Please do not reach out to the client organization directly, as all communication should flow through our team to ensure a professional and coordinated hiring process.

Pay

Compensation details will be discussed during the screening process with our recruiting team.

Equal Employment Opportunity: Get A Job.ai is committed to inclusive hiring practices. We welcome applications from all qualified candidates regardless of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected characteristic under applicable law.