Managed Care Coordinator jobs in Carlsbad, CA

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)

Recently Added Managed Care Coordinator jobs

Data Management Specialist

Southern California Physicians Managed Care...
San Diego, CA FULL_TIME
Department:

Information Technology

Level:

Non-Supervisory

Reports To:

Directory of Information Technology and Security

Private Health Information (PHI):

Position has complete access to electronic PHI.

Job Classification:

Exempt

Job Type:
Full time - Four-Day 10 hour days, Monday - Thursday

Pay Rate:
$33.47 â $42.68 an hour. Salary is based on qualifications and experience.

Position Summary:

Responsible for ensuring that HIPPA compliant formats and best practices are used for electronic data exchange throughout the organization by monitoring and managing the performance of all systems and monitoring adherence to all related policies and procedures.

Essential Job Functions:

This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its' employees will need to assume other "non-essential functions" not listed herein which support company business objectives. This may include duties which fall outside of normal position scope.
Ensures that HIPPA compliant formats and best practices are used for electronic data exchange throughout the organization by monitoring and managing the performance of the Data Warehouse, the Electronic Authorization System, Electronic Claims Systems, Electronic Eligibility and Data Exchange services on the SCPMCS Website and FTP services.
Manages and controls all batch inload/outload of data to the EZ-Cap system to ensure accuracy and timeliness.
Facilitates the transition from manual to electronic communications to achieve greater participation by providers. Works with the Network Management Department to obtain provider participation.
Manages all EDI processing and server data related to all data exchange systems to achieve conformance with policies and procedures. Manages user registration for HealthPlan portals and end user access training.
Recommends data formats and ensures that data content and transmission methods are compliant with HIPAA standards. Recommends organizational wide policies and procedures for data exchange into and out of the organization, and monitors adherence to those procedures.
Participates in regular and temporary teams as assigned by the Director of Information Technology.
Coordinates software Vendors, IT Staff, Providers, Health Plans and SCPMCS Departments to create and maintain HIPAA compliant systems and procedures for data exchange.
Reports all security, privacy and procedure breaches to the Director of Information Technology immediately.
Performs other duties as assigned, including cross training and coverage of the IT Department.

Position Qualifications and Requirements:

Experience/Specialized Skills::

Proven experience managing multiple electronic environments for data exchange with Trading Partners in both batch and interactive environments, internally and externally.

Must be familiar with and have experience with EDI X12 Transaction Sets, EDI Mapping Applications and multiple protocols in a medical transaction environment.

Must have strong working knowledge of Windows Desktop and Server Administration. Working knowledge of MS Office, Excel and Word, and Adobe Acrobat.

Working experience with EZ-Suite (EZ-Cap, EZ-Net) not required by preferred.

Proven ability to work with multiple projects with internal personnel and Trading Partners in a professional manner. Excellent interpersonal skills are essential.

Must be able to occasionally work evenings and weekends as needed.

Education/Course(s) /Training:

â¢ Bachelorâs Degree in Information Systems or Business Administration preferred. Network Administration, Desktop Support and Database Administration a plus.

Licensure/Certification:

N/A

Location:

Mira Mesa, San Diego

Date Posted:

January 25, 2024

To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

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Managed Care Coordinator jobs in Carlsbad, CA

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About Carlsbad, California

What does a Managed Care Coordinator do?