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)
POSITION OVERVIEW:
The Managed Care Coordinator is responsible for the day-to-day functions of collaborative communication with external case managers at referring provider facilities and/or managed care organizations (MCO) for data collection, interpretation, and certification/recertification from third party payers at pre-admission through discharge, ongoing medical necessity reviews and interdisciplinary team support with respect to MCO requisites. In addition, this position is responsible for having a thorough understanding of patient treatment plans through participative discussions with the care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing inpatient and outpatient services requiring MCO approval.
The salary for the Managed Care Coordinator is $53,000.00/Annually based on relevant experience.
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EDUCATION AND REQUIREMENTS:
About Us: Acacia Network, the leading Latino integration care nonprofit in the nation, offers the community, from children to seniors, a pathway to behavioral and primary healthcare, housing, and empowerment. We are visionary leaders transforming the triple aim of high quality, and great experience at a lower cost. Acacia champions a collaborative environment to deliver vital health, housing, and community-building services, work we have been doing since 1969. By hiring talented individuals like you, we've been able to expand quickly, with offices in Albany, Buffalo, Syracuse, Orlando, Tennessee, Maryland, and Puerto Rico.
*Acacia Network is an equal opportunity employer*
Job Type: Full-time
Pay: $53,000.00 per year
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People with a criminal record are encouraged to apply
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Work Location: In person
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