Managed Care Coordinator jobs in Baltimore, MD

Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)

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Manager of Managed Care Contracting
  • Anne Arundel Dermatology
  • Linthicum Heights, MD FULL_TIME
  • Overview

    Reporting to the Chief Compliance Officer, the Manager of Managed Care Contracting is responsible for overseeing the development, strategic planning and execution of managed care contracts for the company through market assessment, financial modeling and relationship management.

     

    Responsibilities

    Supervisory Responsibilities:

    • Recruits, interviews, hires, and trains management level staff in the department.
    • Oversees the schedules and responsibilities of management-level staff in the department.
    • Provides constructive and timely performance evaluations.

    Duties/Responsibilities:

    • Define the strategy for each negotiation, including evaluation of strategic pricing, fee-for service, engagement in value-based contract structures, bundled arrangement, insurer product development, etc. to strengthen the company’s position in the market place.
    • Develops and maintains a network of relationships with third party payers.
    • Drives and maintains strong relationships with internal clinical providers and groups to facilitate and encourage partnership and development.
    • Drafts, reviews and negotiates all managed care payer contracts for assigned payers, including ones flexible enough to respond to an ever-changing market over multi-year agreements.
    • Oversees analytics and other quantitative revenue analysis that supports contract strategy
    • Creates methods to evaluate and analyze existing contracts to determine initiatives for cost reduction and continual improvement.
    • Negotiates contracts and utilizes strategies for the interpretation and assessment of legal and financial implications.
    • Maintains and provides in-depth knowledge of managed care concepts, contracting terms, risk arrangements and State and Federal laws that apply to managed care in order to effectively negotiate or supervise negotiation of agreements with Payors.
    • Collaborates with senior executives to support company growth.
    • Forecasts, drafts, implements, and oversees the department’s operating budget, ensuring maximum utilization of resources for optimal results.
    • Maintains standards and ensures compliance across all managed care contracting related channels.
    • Required to travel as needed.

    Qualifications

    Required Skills/Abilities:

    • Significant knowledge of managed care payer operations and physician contracting
    • Knowledge of current trends in health insurance and the managed care marketplace.
    • Outstanding verbal and written communication skills.
    • Excellent interpersonal and customer service skills.
    • Excellent organizational skills and attention to detail.
    • Professional level knowledge of health care administration, finance and clinical operations.
    • Proficient with Microsoft Office Suite or related software.

    Physical Requirements:

    • Prolonged periods of sitting at a desk and working on a computer.
    • Must be able to lift 15 pounds at times.

     

    Licensure/Certifications/Education

    Education and Experience:

    • Bachelor’s degree in healthcare administration or similar related field. Master’s degree preferred.
    • Five to Seven years progressively responsible experience in health insurance and managed care, with significant leadership experience preferred.
    • Prior experience in the healthcare or dermatology industry is highly desired.
  • 22 Days Ago

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Managed Care Billing Specialist
  • FutureCare
  • Pasadena, MD FULL_TIME
  • Overview At FutureCare our Managed Care Billing Specialist position is a general patient accounting position with a variety of duties related to day to day review, input, processing and coordinating o...
  • Just Posted

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Clinical Quality Managed Care Specialist
  • Johns Hopkins Health Plans
  • Hanover, MD FULL_TIME
  • Who you are: As a Clinical Quality Managed Care Specialist, you are a guru when it comes to working in a NCQA-accredited managed care organization. You not only understand Clinical HEDIS and Stars Mea...
  • 1 Day Ago

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Clinical Quality Managed Care Specialist
  • Johns Hopkins Medicine
  • Hanover, MD FULL_TIME
  • Who you are: As a Clinical Quality Managed Care Specialist, you are a guru when it comes to working in a NCQA-accredited managed care organization. You not only understand Clinical HEDIS and Stars Mea...
  • 4 Days Ago

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Claims Auditor
  • Jai Medical Systems Managed Care Organization, Inc.
  • Cockeysville, MD FULL_TIME
  • Baltimore-based Medicaid Managed Care Organization company is seeking a hardworking and reliable individual for Claims Auditor position. The Claims Auditor will review and analyze claims data, profess...
  • 20 Days Ago

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Managed Care Centralized Business Office Manager
  • CommuniCare Family of Companies
  • Linthicum Heights, MD FULL_TIME
  • CommuniCare Health Services is currently recruiting a Managed Care Team Lead / Centralized Billing Office Manager for our Central Billing Office in Linthicum Heights, MD.PURPOSE/BELIEF STATEMENTThe Ma...
  • 25 Days Ago

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0 Managed Care Coordinator jobs found in Baltimore, MD area

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Client Care Coordinator
  • Breakaway Physical Therapy, LLC
  • Crofton, MD
  • If you enjoy helping people feel good and get their life back, then join our team! We are a rapidly growing privately-ow...
  • 3/29/2024 12:00:00 AM

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Care Coordinator
  • Recovery Centers of America
  • Earleville, MD
  • Position Overview: The Care Coordinator will operate as a member of the multidisciplinary treatment team by working clos...
  • 3/28/2024 12:00:00 AM

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ED CARE COORDINATOR
  • LifeBridge Health
  • Randallstown, MD
  • The Emergency Department Care Coordinator, in collaboration with the clinical team to include the medical provider, deli...
  • 3/28/2024 12:00:00 AM

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Extended Care Coordinator
  • German International School Washington D.C.
  • Potomac, MD
  • Job Description Job Description Who we are: The German International School Washington D.C. is a leading international s...
  • 3/28/2024 12:00:00 AM

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Client Care Coordinator
  • WeCare Private Duty Services, Inc.
  • Pikesville, MD
  • WeCare Private Duty Services, Inc. is a respected leader in home care, is seeking a proactive Customer Service Represent...
  • 3/27/2024 12:00:00 AM

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Home Care Coordinator (LPN/RN)
  • Edenbridge Health
  • Baltimore, MD
  • Role: Home Care Nurse Coordinator Organization: Edenbridge PACE at West Baltimore Location: West Baltimore Start Date: A...
  • 3/27/2024 12:00:00 AM

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Customer Care Coordinator
  • Numotion
  • Baltimore, MD
  • Customer Care Coordinator Tracking Code 8079-128 Job Description By joining Numotion, you will be a part of the nations ...
  • 3/26/2024 12:00:00 AM

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RN Care Coordinator - Grace Medical Center
  • LifeBridge Health
  • Baltimore, MD
  • RN Care Coordinator - Grace Medical Center Baltimore, MD GRACE MEDICAL CENTER FAM H&W CENTER Full-time - Day shift - 8:3...
  • 3/26/2024 12:00:00 AM

Baltimore (/ˈbɔːltɪmɔːr/) is the largest city in the state of Maryland within the United States. Baltimore was established by the Constitution of Maryland as an independent city in 1729. With a population of 611,648 in 2017, Baltimore is the largest such independent city in the United States. As of 2017[update], the population of the Baltimore metropolitan area was estimated to be just under 2.808 million, making it the 20th largest metropolitan area in the country. Baltimore is located about 40 miles (60 km) northeast of Washington, D.C., making it a principal city in the Washington-Baltimo...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$51,002 to $87,530
Baltimore, Maryland area prices
were up 1.5% from a year ago

Managed Care Coordinator in San Francisco, CA
Care managers also sometimes provide case management--for example, information about transportation assistance, food programs, and other social services.
December 12, 2019
Managed Care Coordinator in Santa Barbara, CA
Nursing home administrators manage staff, admissions, finances, and care of the building, as well as care of the residents in nursing homes.
February 02, 2020
Managed Care Coordinator in Orange, CA
Assist with on-boarding and training of new Managed Care Coordinators.
January 20, 2020