Managed Care Coordinator jobs in the United States

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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Managed Care Coordinator
  • Aperion Care
  • Lincolnwood, IL FULL_TIME,PART_TIME
  • SUMMARY: In support of Managed Care Case Management perform the duties of triaging daily referral requests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all facilities. Insures all required information is provided before handing off to Case Managers. Performs insurance verifications for commercial plans as well as plan benefits verifications for all referrals.

    ESSENTIAL DUTIES AND RESPONSIBILITIES:

    • Primary liaison between marketing liaisons, facilities admissions and MCO Case Management for new referrals and readmissions.
    • Communicates and maintains effective working relationships with marketing teams, facility contacts, and case management team as relates to referral process.
    • Performs review of referral requests for completeness of information and determines when ready to move to a case manager for preauthorization.
    • Perform benefit verifications on all referrals adhering to appropriate processes.
    • Able to hold facilities accountable to adhere to the process for referrals to case management of MCO cases.
    • Maintain / Close out Manage Care Referral Log.
    • Assistant to Case Management Consultant – Obtaining Auth, communication with communities, and communication with insurance companies.

    QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

    • College Degree is Preferred
    • Experience working in a skilled nursing facility
    • Understanding of how claims are paid under Commercial and Medicare Advantage plans for skilled services.
    • 2 years working with MCO insurance experience is preferred
    • Self-Starter and results orientated personality.
    • Strong organizational, planning and problem-solving skills.
    • Able to work multiple tasks before a task is completed.
    • Understanding of the differences in types of insurance that is taken at a skilled nursing facility.
    • Working understanding of Medicare rules as it is applied to a skilled nursing facility.

     

     

    PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Must be able to move intermittently throughout the workday.
    • Must be able to speak and write the English language in an understandable manner.
    • Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum of 50 feet.
    • May be necessary to assist in the evacuation of residents during emergency situations.
  • 23 Days Ago

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Care Coordinator
  • Insite Managed Solutions
  • Voorhees, NJ FULL_TIME
  • Job Type: Full-time, In-Office Benefits: Benefits: Paid Training, Medical, Dental, Vision, and Life insurance, PTO, Paid Office Holidays, Paid Sick Time, 401(k) with up to 3% company match, Referral P...
  • 27 Days Ago

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Managed Care Coordinator - Referrals
  • Beth Israel Lahey Health Primary Care
  • Plymouth, MA FULL_TIME
  • When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)This role is ...
  • 7 Days Ago

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Medical Assistant for a Managed Care Clinic
  • EVOLVE MANAGED CARE SOLUTIONS
  • Augusta, GA FULL_TIME
  • Medical Assistant- Managed Care/ Case Management · One (1) year related experience.· CMA certified · Strong interpersonal skills with patients and co-workers.· Proven ability to interact professionall...
  • 1 Day Ago

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Talent acquisition coordinator
  • Managed Care Staffers
  • Fort Wayne, IN FULL_TIME
  • Talent Acquisition Onboarding Coordinator, 12-month assignment, Ft Wayne IN Our client, a large healthcare entity in Fort Wayne, IN, has an opening for a Talent Acquisition Onboarding Coordinator. Und...
  • 28 Days Ago

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Managed Care Coordinator I
  • Spectraforce Technologies
  • Columbia, SC FULL_TIME
  • Job Title: Managed Care Coordinator I Location: Columbia, SC. 29229 (Remote after 1 week onsite training) Duration: 3 months assignment with possible extension. Shift: Mon-Fri, 8:30 am to 5:00 pm. Pay...
  • 18 Days Ago

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Extended Care Coordinator
  • German International School Washington D.C.
  • Potomac, MD
  • Job Description Job Description Who we are: The German International School Washington D.C. is a leading international s...
  • 3/28/2024 12:00:00 AM

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Care Coordinator
  • Gastro Health
  • Reston, VA
  • Gastro Health is seeking a Full-Time Care Coordinator to join our team! Gastro Health is a great place to work and advan...
  • 3/28/2024 12:00:00 AM

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Palliative Care Coordinator
  • Curo Health Services
  • Fairfax, VA
  • Our Company Empatia is a member of the Gentiva family - an industry leader in hospice, palliative, home health, and pers...
  • 3/28/2024 12:00:00 AM

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Wound Care Coordinator - RN
  • Genesis Healthcare
  • Charles Town, WV
  • Benefits*Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off *Variable compensation plans*Diverse, ...
  • 3/28/2024 12:00:00 AM

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Budtender Patient Care Coordinator Full-Time
  • Vireo Health
  • Frederick, MD
  • Who we are Here at Green Goods, our mission is to bring the best of technology, science, and engineering to the cannabis...
  • 3/28/2024 12:00:00 AM

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Field Care Coordinator - Culpeper and Fauquier counties - Remote
  • UnitedHealth Group Inc.
  • Warrenton, VA
  • At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers...
  • 3/26/2024 12:00:00 AM

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Budtender Patient Care Coordinator Part-Time
  • Vireo Health
  • Frederick, MD
  • Who we are Here at Green Goods, our mission is to bring the best of technology, science, and engineering to the cannabis...
  • 3/25/2024 12:00:00 AM

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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, ...
  • 3/24/2024 12:00:00 AM

Income Estimation for Managed Care Coordinator jobs
$49,613 to $85,146