Managed Care Coordinator jobs in Massachusetts

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 - Referrals
  • Beth Israel Lahey Health Primary Care
  • Plymouth, MA FULL_TIME
  • When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

    Job Type:

    Regular

    Scheduled Hours:

    40

    Work Shift:

    Day (United States of America)

    This role is now eligible for a $1,500 sign on bonus. Important Details: Bonuses are paid out in $500 increments at 30 days, 6 months and at the 1 year anniversary. To be eligible, you must be a non-BILH employee or a previous eligible employee who returns to BILH after 1 year. Employee must be in good standing to receive the bonus at the time of payment. All bonuses are subject to applicable taxes. This program is subject to change at any point.

    Job Summary: Under the direction of the Sr. Managed Care Coordinator and Surgery Practice Manager initiate and process managed care insurance referral requests for patients of the practice, while maintaining a strong focus on patient-centered care, timeliness, quality, and accuracy. Adhere to the organization's Revenue Cycle Referral Management policy and meet targets regarding expected standard turnaround time goals as set by the practice.

    Job Description:

    Essential Responsibilities:

    Work collaboratively with APG PCPs, patients and practice support staff to coordinate, and process all specialty care managed care referral authorization requests in compliance with APG's, BIDMC's and BIDPO's contractual rules and agreements for multiple managed care insurance payers. Utilize electronic technologies to initiate, issue, and administratively sign off on a high volume of referrals.

    Learn and remain proficient on multiple electronic technologies used by the APG practices and BIDMC to initiate referral requests in an efficient and timely manner. Technologies will include but are not limited to (POS) Point of Service Device, Health Wire Network, Aetna WebMD, NEHEN, HPHC Connect, and other computer and web-based technology, Navinet and NIA.

    Serve as a daily point of contact and as an organizational resource for APG patients, families, specialty practices, physicians and support staff on APG managed care related issues. Communicate to the specialist and/or patient the level of care, number of visits being authorized (e.g. one consult only vs. a consult and treatment), and the extent of the diagnostic testing being authorized.

    Communicate with managed care payers to resolve patient referral management issues; coordinate with Patient Accounts, and other internal and external customers to resolve patient billing problems. Help provide referral management training to new hires. Work with extremely sensitive and highly confidential patient information and adhere to policy of maintaining patient confidentiality.

    Maintain current knowledge base of referral and authorization plan rules and policies for multiple managed care payers and multiple specialties and ancillary/diagnostic testing as they apply to issuing PCP approvals. Work closely with patients and PCP's to refer patients with complex referral needs and complicated problems or situations to the case management at the insurance companies.

    Required Qualifications:

    High School diploma or GED required.

    Certificate 1 Medical Admin Assistant Cert preferred.

    1-3 years related work experience required.

    Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

    Competencies:

    Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.

    Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.

    Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.

    Team Work: Ability to interact respectfully with other employees, professional staff and/or external contacts to offer ideas, identify issues, obtain information or deliver services.

    Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.


    Physical Nature of the Job:
    Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

    FLSA Status:

    Non-Exempt

    As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

    More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

    Equal Opportunity Employer/Veterans/Disabled

  • 7 Days Ago

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Managed Care Coordinator
  • Beth Israel Lahey Health Performance Network
  • Westwood, MA FULL_TIME
  • When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)The Manager C...
  • 1 Month Ago

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Interventional Radiology Managed Care Coordinator
  • Beth Israel Deaconess Medical Center
  • Boston, MA FULL_TIME
  • When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)Job Summary: ...
  • 12 Days Ago

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Managed Care Coordinator-- Remote Work Eligibility!
  • Beth Israel Deaconess Medical Center
  • Boston, MA FULL_TIME
  • When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Type: Regular Scheduled Hours: 40 Work Shift: Day (United States of America) Job Su...
  • 3 Days Ago

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Managed Care Contract Negotiator
  • Holyoke Medical Center
  • Holyoke, MA FULL_TIME
  • NEGOTIATE AND COORDINATE MANAGED CARE CONTRACT OPERATIONS AND MONITORING, INCLUDING MAINTENANCE AND COMPLIANCE; RECOMMEND MANAGED CARE CONTRACT SOLUTIONS; CULTIVATE AND MANAGE POSITIVE RELATIONSHIPS W...
  • 26 Days Ago

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Managed Care Assistant
  • Family Health Center
  • Worcester, MA FULL_TIME
  • Summary: As a member of the Patient Services Team, the Managed Care Assistant maintains on-gong tracking and documentation on referrals. The Managed Care Assistant ensures complete and accurate regist...
  • 1 Month Ago

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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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Managed Care Coordinator
  • Elevance Health
  • Roanoke, VA
  • Anticipated End Date: 2024-04-22 Position Title: Managed Care Coordinator Job Description: Managed Care Coordinator MUST...
  • 3/27/2024 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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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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Manager Care Coordination
  • Crouse Hospital
  • Syracuse, NY
  • Care Coordination is a collaborative practice model including the multidisciplinary health care team, the patient and fa...
  • 3/24/2024 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...
  • 3/24/2024 12:00:00 AM

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Utilization Management Care Coordinator
  • Humana, Inc.
  • Clarksville, IN
  • Completes inbound and outbound provider calls to answer UM related questions and prepare authorization request for clini...
  • 3/24/2024 12:00:00 AM

Massachusetts is the 7th-smallest state in the United States. It is located in the New England region of the northeastern United States and has an area of 10,555 square miles (27,340 km2), 25.7% of which is water. Several large bays distinctly shape its coast. Boston is the largest city, at the inmost point of Massachusetts Bay, and the mouth of the Charles River. Despite its small size, Massachusetts features numerous topographically distinctive regions. The large coastal plain of the Atlantic Ocean in the eastern section of the state contains Greater Boston, along with most of the state's po...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$53,994 to $92,664

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