Managed Care Coordinator jobs in Kansas
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)
Recently Added Managed Care Coordinator jobs
Credentialing and Managed Care Coordinator
- The US Oncology Network
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Wichita, KS
OTHER
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Overview:
At the Cancer Center of Kansas, we value each and every employee for their life-saving expertise and the role they play in making our patients' lives as easy and comfortable as possible. Our employees are our most valuable resource. They help us create the warm and caring environment that's the foundation for some of the best cancer research and care in the country. If you would like to join a team dedicated to improving lives every day, contact us below.
Responsibilities:
SCOPE: Under general supervision, applies credentialing knowledge to efficiently coordinate provider credentialing, licensure and hospital privileges activities. Assists in administrative activities to support state/practice managed care functions, which may include provider plan participation and credentialing, contract files, explanation of benefits (EOB) analysis and managed care reporting. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:- Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommends process improvements.
- Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers.
- Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
- May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payor and other contracted service providers (labs, hospitals).
- May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payors according to policy and procedure. May produce monthly managed care reports and implement new analysis tools to assist in reporting functions.
- May maintain expected reimbursement by CPT code for the top payor contracts in each market and communicate changes to system librarian.
- May develop and provide maintenance of proformas for all contracts.
- Supports Network Contracting Representative/Manager in general administrative functions.
- Trains junior and practice staff with respect to managed care contracts, policies and procedures.
- Other duties as requested or assigned.
MINIMUM QUALIFICATIONS:
High school diploma or equivalent required. Associates Degree preferred. At least three (3) years physician credentialing and/or managed care support experience required.
COMPETENCIES:- Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded a san expert in the technical/functional area; accesses and uses other expert resources when appropriate. -
- Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn the face of constraints, frustrations, or adversity; demonstrates flexibility.
- Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
- Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
- Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies.
PHYSICAL DEMANDS:
The physical demands described here 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. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
WORK ENVIRONMENT:
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. - 14 Days Ago
Medical record clerk
- Centurion Managed Care
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Topeka, KS
FULL_TIME
- Job Details Description Centurion is proud to be the provider of comprehensive healthcare services to the Kansas Department of Corrections. We are currently seeking a Part-time Medical Records Clerk t...
- 17 Days Ago
Salon Coordinator
- Sport Clips - Coordinator - KS202
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Lawrence, KS
FULL_TIME
- Sport Clips is seeking a dynamic and enthusiastic Student Intern to join our team and play a pivotal role in delivering exceptional customer service and ensuring the smooth operation of our salon. If ...
- 6 Days Ago
Care Coordinator
- A Helping Hand Home Health Care
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Lawrence, KS
FULL_TIME
- We're looking for a Care Coordinator to join our team. If you're looking to make a difference, enjoy spending time with others, and want to join a fun and supportive community then you've come to the ...
- 5 Days Ago
Care Coordinator
- A Helping Hand Home Health Care
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Topeka, KS
FULL_TIME
- We're looking for a Care Coordinator to join our team. If you're looking to make a difference, enjoy spending time with others, and want to join a fun and supportive community then you've come to the ...
- 5 Days Ago
Nurse Resident Care Coordinator
- Recover-Care
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Baldwin, KS
FULL_TIME
- As a Resident Care Coordinator you are responisble for assisting the MDS Coordinator with ensuring that documentation in the center meets Federal, State, and Certification guidelines. The Resident Car...
- 19 Days Ago
Managed Care Coordinator jobs at Popular Companies
Manager Care Coordination
- hireneXus Research
-
San Francisco, CA
- Manager Care Coordination Population Health San Francisco Bay Area Here are some of the benefits our client offers! HUGE...
- 4/23/2024 12:00:00 AM
office manager/ care coordinator
- 5 Stars Home Care LLC
-
Alexandria, VA
- Job Description Job Description Job Summary: Duties: Responsible for all areas of Operations; human resources, intakes, ...
- 4/23/2024 12:00:00 AM
Credential and Managed Care Coordinator
- Us Oncology Network-wide Career Opportunities
-
Norfolk, VA
- OverviewVirginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Ca...
- 4/22/2024 12:00:00 AM
RN - Registered Nurse Case Manager - Care Coordination
- Geisinger
-
Wilkes Barre, PA
- Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
- 4/22/2024 12:00:00 AM
Case Manager (Care Coordinator)
- Pacifica Hospital of the Valley
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Los Angeles, CA
- Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
- 4/20/2024 12:00:00 AM
Manager Care Coordination
- Hirenexus Research
-
San Francisco, CA
- Manager Care Coordination Population Health San Francisco Bay Area Here are some of the benefits our client offers! HUGE...
- 4/20/2024 12:00:00 AM
Managed Care Coordinator - Referrals
- Beth Israel Lahey Health
-
Plymouth, MA
- **When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.** **Job...
- 4/19/2024 12:00:00 AM
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) ...
- 4/19/2024 12:00:00 AM
About Kansas
Kansas /ˈkænzəs/ (listen) is a U.S. state in the Midwestern United States. Its capital is Topeka and its largest city is Wichita, with its most populated county being Johnson County. Kansas is bordered by Nebraska on the north; Missouri on the east; Oklahoma on the south; and Colorado on the west. Kansas is named after the Kansa Native American tribe, which inhabited the area. The tribe's name (natively kką:ze) is often said to mean "people of the (south) wind" although this was probably not the term's original meaning. For thousands of years, what is now Kansas was home to numerous and divers...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$46,896 to $80,480
Most Popular Cities in Kansas for Managed Care Coordinator Jobs
What does a Managed Care Coordinator do?
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