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)
Managed Care Coordinator MUST LIVE WITHIN THE TIDEWATER REGION (Accomack County, Chesapeake County, Franklin City, Isle of Wight County, Hampton City, Norfolk City, Newport News City, North Hampton County, Portsmouth City, Suffolk City, Virginia Beach City, VA) A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. The Managed Care Coordinator is responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract. How you will make an impact: Minimum Requirements: Preferred Skills, Capabilities, and Experiences:
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