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)
The care coordinator/care coach in conjunction with physician and mid-level staff participates in the preparation and coordination of care of our patient population. Health Population includes but is not limited to Wellmed, Cigna, and other Medicare Advantage Plans.
The care coordinator attends and participates in administrative meetings, conducts care coordination planning, chronic care management, tracks, and measures different quality initiatives.
1. Supports the mission and vision of Donna Medical Clinic, PA.
2. Works cooperatively with medical director and management to develop and promote education to all support & medical staff.
3. Maintains a clear, continuous QI strategy and process that includes regular review of performance data and evaluation of performance against goals or benchmarks established by the ACO and or insurance plans. The QI process allows the practice to identify and prioritize areas for improvement, analyze potential barriers to meeting goals and plan methods for addressing the barriers. To facilitate the QI process, the care coordinators commit to ongoing QI, beyond setting goals and taking actions.
4. Quality Initiatives / goals are gathered from immunization measures, preventive care measures, chronic care measures, acute care measures, care coordination measures, utilization measures affecting health care costs, and measures related to the practices vulnerable population to assess the disparities of care. The Medical Director in conjunction with the care coordination team and management team decide on the data, a specific time and persons responsible.
5. Assists and leads weekly team huddles in the review of population health data: Practice-level and individual provider-level performance results are shared with team
Reports reflect the care provided by the care team.
6. Mmonitor’s performance on all measures, striving for improvement in the process as well as the results.
7. Maintains Chronic Care Management roster.
8. Maintains Hospital Discharges Roster.
9. Reviews and participates in periodic complex care management. 10. Attends staff and medical meeting as require.
Job Type: Full-time
Pay: From $11.00 per hour
Expected hours: 40 per week
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Work Location: In person
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