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)
ScionHealth is recruiting for a Director of Managed Care Analytics to join our team!
Job Summary
The Director of Managed Care Analytics is responsible for supporting the Vice President Managed Care as well as the Managed Care Contracting team in contract modeling, strategic planning, budgeting, financial analysis, and evaluating potential acquisitions. This role supports managed care, hospital operations, and physician operations across the ScionHealth enterprise by providing analysis managed care financial metrics, including but not limited to volume trends, contract yield, financial performance analysis, benchmarking, and trend analyses to support strategic pricing.
Primary Responsibilities
Education
Bachelor's degree in Business Administration, Accounting, Finance, or commensurate experience in Health Care or Managed Care industry.
Licensure/Certification
Project Management certification preferred, but not required.
Experience
8-10 years of progressive experience in financial and data analysis in the Healthcare industry.