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)
Guidance Care HMO is looking to hire Full Time employees in our Liaison Department.
Our Liaison Department assists nursing homes with various billing inquiries and other issues related to Managed Care.
Applicants must have experience in either medical billing or case management (authorization requests, clinical review processes etc.) as it relates to skilled nursing facilities.
The position requires exceptional organization skills as well the ability to multitask in a fast paced work environment. Proficiency in EMR’s preferred.
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