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)
Located in Kailua, Adventist Health Castle has been one of the area's leading healthcare providers since 1963. We are comprised of a 160-bed hospital, eight medical offices, home care services, urgent cares and a vast scope of services located throughout O'ahu. In 2017, Adventist Health Castle was recognized with the Malcolm Baldrige National Quality Award, the nation's highest presidential honor for performance excellence. O'ahu is known for its ideal climate, diverse culture and picturesque landscape. The allure of Castle's laid-back lifestyle is complimented by its close-knit and proud community.
Job Summary:
Works with multidisciplinary healthcare teams in assigned physician offices settings. Focuses on coaching and coordination of care for designated patients as well as motivating high-risk patient populations to complete wellness screenings as required by individual health plans. Works alongside the physicians and office staff to identify needs of patients while assisting the practice to develop a process for managing its patient population. Promotes patient-centered care, works side-by-side with physicians and medical home/neighborhood team members, and actively participates in multidisciplinary patient-centered team meetings.
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Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.