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)
Summary
Care Coordinators provide a single point of accountability for ensuring that medically necessary services and supports are accessed, coordinated, and delivered in a strengths-based, individualized, family/youth driven, and ethnically, culturally, and linguistically relevant manner. The Care Coordinator will be able to provide services at the Wraparound and/or Service Coordination level within the Health Team as needed.
Essential Functions
Qualifications
Benefits (Full-Time Staff Only)
All Red Rock BHS employees are required to be fully vaccinated, as per Centers of Medicare and Medicaid Services Standards, unless otherwise exempt.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
Red Rock Behavioral Health Services does not discriminate based on race, color, national origin, religion, gender, gender identity, age, marital/familial status, sexual orientation, or disability.
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