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)
Summary:The Senior Contract Manager, Contract Manager is responsible for the implementation and facilitation of managed care contracts, contract compliance, and related activities for CharterCARE Health Partner System under the direction of the Senior Director, Managed Care Operations and Payer Relation.
Education: Bachelor’s degree in health care administration or related field; Master’s Degree preferred.
Experience: A minimum of 7 years’ of managed care contracting for multi-hospital system and or health plan(s) and reimbursement analysis in either a provider or payer setting required. Experience with risk and value-based arrangements.
Skills and Abilities:
Clear All
0 Managed Care Coordinator jobs found in Providence, RI area