Managed Care Coordinator jobs in Illinois

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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Managed Care Coordinator
  • Aperion Care
  • Lincolnwood, IL FULL_TIME,PART_TIME
  • SUMMARY: In support of Managed Care Case Management perform the duties of triaging daily referral requests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all facilities. Insures all required information is provided before handing off to Case Managers. Performs insurance verifications for commercial plans as well as plan benefits verifications for all referrals.

    ESSENTIAL DUTIES AND RESPONSIBILITIES:

    • Primary liaison between marketing liaisons, facilities admissions and MCO Case Management for new referrals and readmissions.
    • Communicates and maintains effective working relationships with marketing teams, facility contacts, and case management team as relates to referral process.
    • Performs review of referral requests for completeness of information and determines when ready to move to a case manager for preauthorization.
    • Perform benefit verifications on all referrals adhering to appropriate processes.
    • Able to hold facilities accountable to adhere to the process for referrals to case management of MCO cases.
    • Maintain / Close out Manage Care Referral Log.
    • Assistant to Case Management Consultant – Obtaining Auth, communication with communities, and communication with insurance companies.

    QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

    • College Degree is Preferred
    • Experience working in a skilled nursing facility
    • Understanding of how claims are paid under Commercial and Medicare Advantage plans for skilled services.
    • 2 years working with MCO insurance experience is preferred
    • Self-Starter and results orientated personality.
    • Strong organizational, planning and problem-solving skills.
    • Able to work multiple tasks before a task is completed.
    • Understanding of the differences in types of insurance that is taken at a skilled nursing facility.
    • Working understanding of Medicare rules as it is applied to a skilled nursing facility.

     

     

    PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Must be able to move intermittently throughout the workday.
    • Must be able to speak and write the English language in an understandable manner.
    • Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum of 50 feet.
    • May be necessary to assist in the evacuation of residents during emergency situations.
  • 24 Days Ago

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Managed care coordinator
  • Burrell Behavioral Health
  • Quincy, IL FULL_TIME
  • Job Description : Managed Care Data Coordinator Remote / WFH (Work from Home) or in-person options Job Summary : Join our dynamic team as a Managed Care Data Coordinator and work remotely or in-person...
  • 1 Month Ago

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Care Coordinator - Managed Care Coordination
  • ACCESS Community Health Network
  • Chicago, IL FULL_TIME
  • Position Summary The Care Coordinator is a Licensed Social Worker or Counselor who provides care coordination, social support services and outreach services to assist patients in navigating health car...
  • 13 Days Ago

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Managed Care Manager
  • Aperion Care
  • Lincolnwood, IL FULL_TIME
  • Description: In support of Managed Care Case Management perform the duties of facilitating daily referral request for all Commercial, MMAI and Medicare Advantage plans for skilled care stays for all A...
  • 22 Days Ago

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Senior Associate, Managed Care
  • Hopscotch Primary Care
  • Chicago, IL FULL_TIME
  • About the Role The Managed Care Senior Associate will be a key member of the Managed Care team, responsible for supporting Hopscotch's managed care strategy spanning payer relations, financial analysi...
  • 6 Days Ago

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Physician Credentialing Specialist
  • Managed Care Staffers
  • Chicago, IL FULL_TIME,CONTRACTOR,TEMPORARY
  • Physician Credentialing Specialist, Chicago Loop (Contract to hire) Our client, that provides physician management services on behalf of the U of IL Physician Group has an immediate staffing need for ...
  • 1 Month Ago

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Manager Care Coordination
  • Crouse Hospital
  • Syracuse, NY
  • Care Coordination is a collaborative practice model including the multidisciplinary health care team, the patient and fa...
  • 3/29/2024 12:00:00 AM

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Manager Care Coordination
  • Catholic Health Services
  • West Islip, NY
  • Overview Manager of Care Coordination (MCC) - Registered Nurse (RN) Are you exceedingly driven, dedicated, and passionat...
  • 3/29/2024 12:00:00 AM

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Manager Care Coordination
  • St. Catherine of Siena
  • West Islip, NY
  • Overview Manager of Care Coordination (MCC) - Registered Nurse (RN) Are you exceedingly driven, dedicated, and passionat...
  • 3/29/2024 12:00:00 AM

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Managed Care Coordinator - Referrals
  • Beth Israel Lahey Health
  • Boston, MA
  • When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Typ...
  • 3/28/2024 12:00:00 AM

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Manager-Care Coordination
  • St. Catherine of Siena
  • Rockville Centre, NY
  • Overview Manager, Care Coordination (RN), Rockville Centre, NY Explore a career with Mercy Hospital, a 375-bed not-for-p...
  • 3/26/2024 12:00:00 AM

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Managed Care Coordinator
  • MJHS Health System
  • New York, NY
  • Req #: 1509 Job ID: 13084 Job Location(s): New York, NY Zip Code: 10040 Category: Office and Administrative Support Agen...
  • 3/26/2024 12:00:00 AM

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Manager, Care Coordination
  • SCAN
  • Long Beach, CA
  • About SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adult...
  • 3/26/2024 12:00:00 AM

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Case Manager (Care Coordinator)
  • Pacifica Hospital of the Valley
  • Los Angeles, CA
  • Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
  • 3/26/2024 12:00:00 AM

Illinois (/ˌɪlɪˈnɔɪ/ (listen) IL-ih-NOY) is a state in the Midwestern and Great Lakes region of the United States. It has the fifth largest gross domestic product (GDP), the sixth largest population, and the 25th largest land area of all U.S. states. Illinois is often noted as a microcosm of the entire United States. With Chicago in northeastern Illinois, small industrial cities and immense agricultural productivity in the north and center of the state, and natural resources such as coal, timber, and petroleum in the south, Illinois has a diverse economic base, and is a major transportation hu...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$50,977 to $87,487

Managed Care Coordinator in New Orleans, LA
Health systems must meet the operational challenge of managing provider data for thousands of participating providers in their value-based care networks.
January 11, 2020
Managed Care Coordinator in Gainesville, FL
Many telehealth programs give patients easy access to any additional educational materials provided by their health plan or primary care provider.
December 23, 2019
Managed Care Coordinator in Houston, TX
Works with relevant parties to ensure deliverable from all parties are achieved in accordance with strategic timelines.Maintains CHSLI master list of service locations (facility, professional and continuing care)Assists in the resolution of referral, authorization and claims payment issuesSupports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements.
December 27, 2019