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. 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. Typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). Has gained full p ...roficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. Typically requires 5-7 years of related experience.More Show Less
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A company is looking for a Managed Care Coordinator I.Key Responsibilities : Review service requests for completeness and collect non-clinical dataPrepare and document cases for clinical review and coordinate with members and providersAssist members with finding providers and resolving issues related to servicesRequired Qualifications : High School Diploma / GED required1-2 years of experience in customer service or medical support preferredKnowl...
Job Description. Job Description. The Managed Care Coordinator completes insurance requirements and provides case management as needed for services performed in various patient seeing settings. The individual obtains and provides insurance benefit information to patients and patient care departments. The Managed Care Coordinator assists patients and providers with developing strategies for alternative options for non-covered services by communica...
Managed Care Coordinator is responsible for maintaining contracting platforms internally and externally for PACS affiliated facilities. Directly supports the Managed Care Department by completing Health Plan applications, submitting credentialing documents, notifying facilities on contracts and providing education on accessing contracts. Responsible for maintaining credentialing status of Skilled Nursing Facilities with Health Plans by submitting...
