Managed Care Coordinator jobs in North Carolina
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
Managed Care Coordinator (3147) - Full Time
- Wilmington Health PLLC
-
Wilmington, NC
FULL_TIME
-
Purpose:
Processes all referral forms and answers all patient and employee questions regarding previously requested authorization
Essential Duties/Responsibilities:
Processes all authorizations requiring prior approval from the managed care company.
Enters all authorization numbers into Experior.
Faxes all referral forms to specialists.
Files all referral forms.
Answers all incoming calls referred to their respective number.
Takes messages, orders charts when necessary and relays messages in a timely fashion (does not triage).
Screens patient calls, provides requested information, or refers to appropriate department.
Assists all WH clinical staff on a daily basis with any managed care questions.
Returns all Email in prompt manner.
Communicates with insurance companies.
Communicates with specialist’s offices.
Attends clinical staff meetings and other meetings as required by the department managers.
Maintains patient confidentiality.
Arranges seminars and educational meetings with WH clinical staff and physicians.
Works on special projects as required.
Works with Business Office account representatives on claims follow-up and re-filing;
Other Duties:As assigned by manager
Qualifications:
Required:
High school diploma, GED, or high school equivalency
3 to 5 years' experience in a medical office environment;
or equivalent combination of education and experience.
Preferred:
Managed Care Coordinator Competencies
General- Customer Service
- Professionalism/Integrity/Responsibility
- Teamwork/Process Focus
- Dependability/Punctuality
- Interpersonal Relationships/Communication
- Judgment/Decision Making/Problem Solving
- Quality/Quantity
- Initiative
- Safety/Housekeeping
- Organizational Skills/Time Management
Department Specific
- Processes all pre-certs and prior authorizations within 48 hours for evaluate and treats.
- Processes all surgeries and procedures five days prior to appointment.
- Completes all retro requests within five days.
- Processes all mail and correspondence on a daily basis.
- Copies monthly Medicaid enrollment for all locations by the fifth of each month.
- Maintains up-to-date information re: managed care plans. Distributes necessary updates to staff/management.
- 21 Days Ago
Managed Care Analyst / Managed Care / Full-Time
- Catawba
-
Claremont, NC
FULL_TIME
- Summary: Position is responsible for working with various internal and external customers regarding contract payor terms, policy/procedure updates, payor administration, variances/contract modificatio...
- 1 Month Ago
Manager - Managed Care Contracting
- Candidate Experience site
-
Charlotte, NC
FULL_TIME
- Job Summary Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract lang...
- 7 Days Ago
Manager - Managed Care Contracting
- Candidate Experience site
-
Charlotte, NC
FULL_TIME
- Job Summary Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract lang...
- 7 Days Ago
Director Managed Care Contracting
- ECU Health
-
Greenville, NC
FULL_TIME
- ECU Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system ...
- 1 Month Ago
Managed Care Specialist
- Candidate Experience site
-
Charlotte, NC
FULL_TIME
- Job SummaryManages administration of the contract portfolio and the day-to-day relationships between the System and Managed Care Organizations (MCOs) within that portfolio. Coordinates the financial, ...
- 25 Days Ago
Managed Care Coordinator jobs at Popular Companies
Department Manager, Care Coordination
- Weeks Medical Center - CARE MANAGEMENT
-
Lancaster, NH
- Position Details Employment Status: Full-Time Hours/Pay Period: 80 Is Remote: No Shift: Days Work Schedule: M - F Job Su...
- 4/26/2024 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) ...
- 4/25/2024 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...
- 4/25/2024 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) ...
- 4/24/2024 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...
- 4/24/2024 12:00:00 AM
RN Utilization Management Managed Care Coordinator
- Professional Management Enterprises
-
Columbia, SC
- Job Description Job Description Seeking an RN with Managed Care and Utilization Management experience to review and eval...
- 4/24/2024 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...
- 4/23/2024 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
About North Carolina
North Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the southeastern region of the United States. It borders South Carolina and Georgia to the south, Tennessee to the west, Virginia to the north, and the Atlantic Ocean to the east. North Carolina is the 28th-most extensive and the 9th-most populous of the U.S. states. The state is divided into 100 counties. The capital is Raleigh, which along with Durham and Chapel Hill is home to the largest research park in the United States (Research Triangle Park). The most populous municipality is Charlotte, which is the second-largest banking center in...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$47,290 to $81,157
Most Popular Cities in North Carolina 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