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)
We are looking for a Managed Care Auditor to join our growing government-based healthcare practice. Please contact me for details.
Managed Care Auditor wanted …
Established in January, 2005, our audit firm, based in Baltimore, MD is dedicated to health care compliance of government providers, health plans and contractors. Government health care compliance services represent a large portion of our firm’s clients. We audit some of the largest & most complex health care organizations in the country utilizing a team approach drawing on various areas and levels of expertise.
As a Managed Care Auditor on our Assurance Team, you will be involved with compliance audits, examinations, and agreed-upon procedure engagements. You will also apply your experience and knowledge of patient care and/or operational processes by making suggestions to improve client internal controls and operational procedures.
Position Summary: Managed Care Auditor
The Managed Care Auditor will participate in team webinar audits focusing on compliance reviews. Audit teams include Part C Organization Determinations, Appeals and Grievances (ODAG); Medicare-Medicaid Plan (MMP) Service Authorization Requests, Appeals, and Grievances (SARAG); Special Needs Plans Care Coordination (SNPCC); Medicare-Medicaid Plan Care Coordination (MMPCC); and Compliance Program Effectiveness (CPE). The position is responsible for reviewing policies and procedures, internal controls, and claims / medical records to determine a Plan Sponsor’s compliance with Medicare rules and regulations. All necessary training will be provided including working on various teams to gain direct experience on the process. Minimal to no travel required.
Desirable background:
Job Type: Full-time
Pay: $90,000.00 - $100,000.00 per year
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Work Location: Hybrid remote in Nottingham, MD 21236
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