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)
*All positions are located in Fresno/Clovis CA*
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Provide assistance to the Director of Managed Care. Supports, at various levels of responsibility, activities related to the contracting and contract management process for facility, physician, ancillary and CMC health plan contracts. Responsible for contract administration activities, including facilitating and ensuring contract compliance, developing and maintaining contract detail reports, provider databases and demographic information. Responsible for physician contract files including development of contracts and addendums, correspondence and maintenance. Coordinates contract implementation and resolution of contractual issues with payors, facilities, physicians and internal operational staff.
Minimum required:
Preferred:
• Pay ranges listed are an estimate and subject to change.• If any bonuses are noted, they are only applicable to external hires meeting criteria.
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