Care Coordinator

About the role

The Care Coordinator will oversee and coordinate medical care for members of the HMO, ensuring that services are appropriate, timely, and aligned with clinical guidelines. Working closely with providers, internal teams, and members, the role supports continuity of care and high‑quality outcomes.

Key responsibilities

• Review and coordinate member care, including admissions, referrals, and specialist consultations.
• Assess clinical information to determine medical necessity and appropriateness of treatments.
• Monitor ongoing treatment plans, outcomes, and provide clinical guidance to providers and members.
• Conduct utilization management reviews for authorizations, procedures, and high‑cost treatments, recommending cost‑effective alternatives when needed.
• Liaise with hospitals, clinics, and specialists to facilitate service delivery and clarify care pathways.
• Maintain accurate medical records, care notes, and authorization decisions.
• Prepare clinical reports for internal review and participate in audits and quality‑improvement initiatives.

Required profile

• Mid‑level professional with at least 3 years (36 months) of relevant experience.
• Strong understanding of HMO clinical guidelines, utilization management, and regulatory standards.
• Excellent communication skills for provider and member engagement.
• Ability to handle confidential information and uphold data protection standards.

Required skills

• Clinical review and care planning.
• Utilization management and medical authorization processes.
• Provider engagement and member support.
• Documentation and reporting compliance.