Managed Care Coordinator jobs in Virginia

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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Credential and Managed Care Coordinator
  • Virginia Oncology Associates
  • Norfolk, VA FULL_TIME
  • Overview:



    Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Credentialing Managed Care Coordinator for our office in Norfolk.

    ***Please take this quick survey once you've submitted your resume to complete the application process: Credential and Managed Care PI Survey
    Responsibilities:
    • Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommends process improvements.
    • Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers.
    • Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
    • May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payer and other contracted service providers (labs, hospitals).
    • May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payers according to policy and procedure. May produce monthly managed care reports and implement new analysis tools to assist in reporting functions.
    • May maintain expected reimbursement by CPT code for the top payer contracts in each market and communicate changes to system librarian.
    • May develop and provide maintenance of proformas for all contracts.
    • Supports Network Contracting Representative/Manager in general administrative functions.
    • Trains junior and practice staff with respect to credentialing contracts, policies and procedures.
    • Other duties as requested or assigned.
    Qualifications:
    • High school diploma or equivalent required.
    • Technical certification or Associates Degree a plus.
    • At least five (5) years of credentialing related work experience required.
    • Proficiency with computer systems and Microsoft (Office Outlook, Word, Power Point, and Excel) required.
    • CPCS certification is preferred.
  • 11 Days Ago

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Managed Care Coordinator - Foster Care
  • The Elevance Health Companies, Inc.
  • NORFOLK, VA OTHER
  • Anticipated End Date: 2024-06-03 Position Title: Managed Care Coordinator - Foster Care Job Description: The Foster Care Managed Case Manager is responsible for overall management of member's individu...
  • 1 Day Ago

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Managed Care Coordinator - Foster Care
  • Elevance Health
  • Norfolk, VA FULL_TIME
  • Job Family: MED > Care Coord & Care Mgmt (Non-Licensed) Type: Date Posted: Apr 16, 2024 Anticipated End Date: May 20, 2024 Reference: JR113650 Description The Foster Care Managed Case Manager is respo...
  • 7 Days Ago

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Case Manager (Managed Care Coordinator)
  • Elevance Health
  • Virginia, VA FULL_TIME
  • Description Case Manager (Managed Care Coordinator) MUST LIVE WITHIN 50 MILES OF THE ARLINGTON PULSEPOINT A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly...
  • 26 Days Ago

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Managed Care Coordinator (LPC, LCSW, LBBSW, LMSW, QMHP-A&C, or LPN)
  • Elevance Health
  • VA, VA FULL_TIME
  • Description Managed Care Coordinator Location: Candidate must reside in Virginia, preferably in or around Richmond or Roanoke, VA. While primarily remote, occasional visits to facilities or meeting me...
  • 29 Days Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Virginia, VA FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
  • 1 Month Ago

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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

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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

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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

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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

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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

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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

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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

5
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

Virginia (/vərˈdʒɪniə/ (listen)), officially the Commonwealth of Virginia, is a state in the Southeastern and Mid-Atlantic regions of the United States located between the Atlantic Coast and the Appalachian Mountains. Virginia is nicknamed the "Old Dominion" due to its status as the first English colonial possession established in mainland North America and "Mother of Presidents" because eight U.S. presidents were born there, more than any other state. The geography and climate of the Commonwealth are shaped by the Blue Ridge Mountains and the Chesapeake Bay, which provide habitat for much of ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$49,408 to $84,792

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