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)
The Care Coordinator directly interacts with Health Home service beneficiaries and is responsible for the conversion of beneficiaries from outreach to engaged. Care Coordinator works with beneficiary to develop a Health Action Plan that includes a client-driven long-term goal, coinciding short-term goals and specific action steps as well as required and clinically indicated screenings. The Care Coordinator is responsible for supporting beneficiaries and their families in coordinating the beneficiary’s healthcare services and increasing the beneficiary’s and family’s knowledge and skills to be able to self-manage healthcare needs. The Care Coordinator provides six Health Home services to beneficiaries on caseload as appropriate and needed. These services include comprehensive care management, care coordination and health promotion, transitional care planning and follow-up services, individual and family education and collaboration, community and social support services referral coordination, and use of health information technology. The Care Coordinator will communicate with authorizing entities and the beneficiary’s interdisciplinary team to ensure quality and continuity of care according to beneficiary’s goals.
Job Types: Full-time, Part-time
Pay: $23.00 - $30.00 per hour
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Work Location: In person
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