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)
Description
Reporting Office: Eastern (Franklin)
Covering Region/Community: Eastern
SUMMARY
Under the Money Follows the Person (MFP) program, works with consumers, families, providers, landlords, property owners and other staff to coordinate, manage, and implement housing tools, resources and inventories to ensure that consumers secure safe and appropriate housing. Performs all duties in a manner that fosters the achievement of the organization’s mission to identify choices and provide services to help people of all ages, abilities and incomes to live at home.
KEY RESPONSIBILITIES
Requirements
QUALIFICATIONS
Education
Experience
Other
Physical Requirements
Physical Activity Approximate Percentage of Time Spent in this Activity
Work Environment (a brief description)
Work is performed primarily in an office environment but may also include visiting client in hospitals, nursing homes and other locations. By nature of work assigned, employee may be at risk to blood borne pathogens. Personal protective equipment (PPE) may be required for some duties. Contact with staff from other departments likely.
The physical requirements and description of the work environment are representative of what an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
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