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)
MDS / Care Plan Coordinator
Job Summary:
The MDS / Care Plan Coordinator is responsible for assuring the timely completion of accurate resident assessments and interdisciplinary care plans that meet Federal and State guidelines. This includes identifying resident acuity and needs, helping to determine specific care needs, and communicating needs and expectations to families and responsible parties.
Essential Duties:
· Responsible for integrating nursing, dietary, social recreation, restorative, rehabilitation, and physician services to ensure appropriate assessment and reimbursement.
· Responsible for completion of all Medicare/Medicaid case-mix documents to assure appropriate reimbursement for care and services provided within the Facility.
· Conducts continual Minimum Data Set (MDS) reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category.
· Oversees the overall process and tracking of MDS/Prospective Payment System (PPS) documentation and submission.
Benefits Offered:
Preferred Qualifications:
· Registered Nurse with current unencumbered state licensure.
· Long Term Care Experience preferred.
· Ability to read, write, speak, and understand the English language.
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