Managed Care Coordinator jobs in Tinley Park, IL

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)

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Managed Care Coordinator
  • Aperion Care
  • Lincolnwood, IL FULL_TIME,PART_TIME
  • SUMMARY: In support of Managed Care Case Management perform the duties of triaging daily referral requests for all Commercial, MMAI, and Medicare Advantage plans for skilled care stays for all facilities. Insures all required information is provided before handing off to Case Managers. Performs insurance verifications for commercial plans as well as plan benefits verifications for all referrals.

    ESSENTIAL DUTIES AND RESPONSIBILITIES:

    • Primary liaison between marketing liaisons, facilities admissions and MCO Case Management for new referrals and readmissions.
    • Communicates and maintains effective working relationships with marketing teams, facility contacts, and case management team as relates to referral process.
    • Performs review of referral requests for completeness of information and determines when ready to move to a case manager for preauthorization.
    • Perform benefit verifications on all referrals adhering to appropriate processes.
    • Able to hold facilities accountable to adhere to the process for referrals to case management of MCO cases.
    • Maintain / Close out Manage Care Referral Log.
    • Assistant to Case Management Consultant – Obtaining Auth, communication with communities, and communication with insurance companies.

    QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required.

    • College Degree is Preferred
    • Experience working in a skilled nursing facility
    • Understanding of how claims are paid under Commercial and Medicare Advantage plans for skilled services.
    • 2 years working with MCO insurance experience is preferred
    • Self-Starter and results orientated personality.
    • Strong organizational, planning and problem-solving skills.
    • Able to work multiple tasks before a task is completed.
    • Understanding of the differences in types of insurance that is taken at a skilled nursing facility.
    • Working understanding of Medicare rules as it is applied to a skilled nursing facility.

     

     

    PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Must be able to move intermittently throughout the workday.
    • Must be able to speak and write the English language in an understandable manner.
    • Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum of 50 feet.
    • May be necessary to assist in the evacuation of residents during emergency situations.
  • 23 Days Ago

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Care Coordinator - Managed Care Coordination
  • ACCESS Community Health Network
  • Chicago, IL FULL_TIME
  • Position Summary The Care Coordinator is a Licensed Social Worker or Counselor who provides care coordination, social support services and outreach services to assist patients in navigating health car...
  • 12 Days Ago

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Managed Care Manager
  • Aperion Care
  • Lincolnwood, IL FULL_TIME
  • Description: In support of Managed Care Case Management perform the duties of facilitating daily referral request for all Commercial, MMAI and Medicare Advantage plans for skilled care stays for all A...
  • 21 Days Ago

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Senior Associate, Managed Care
  • Hopscotch Primary Care
  • Chicago, IL FULL_TIME
  • About the Role The Managed Care Senior Associate will be a key member of the Managed Care team, responsible for supporting Hopscotch's managed care strategy spanning payer relations, financial analysi...
  • 5 Days Ago

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Physician Credentialing Specialist
  • Managed Care Staffers
  • Chicago, IL FULL_TIME,CONTRACTOR,TEMPORARY
  • Physician Credentialing Specialist, Chicago Loop (Contract to hire) Our client, that provides physician management services on behalf of the U of IL Physician Group has an immediate staffing need for ...
  • 1 Day Ago

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Certified Medical Assistant (CMA)
  • Managed Care Staffers
  • Chicago, IL PART_TIME
  • Temp to Hire P/T CMA for large Nephrology Practice. Two locations Advocate Trinity & Munster, IN Office $27/hr Part-time CMA Position (3 days/wk.)24 hours/wk. (Tues, Wed, & one other day which varies ...
  • 2 Days Ago

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0 Managed Care Coordinator jobs found in Tinley Park, IL area

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Customer Care Coordinator
  • NextGen Global Resources
  • Elgin, IL
  • Job Description Job Description Job Description Experience: Prior experience in a direct customer interfacing role is re...
  • 3/28/2024 12:00:00 AM

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Special Care Coordinator
  • Harmony Healthcare & Rehabilitation Center
  • Chicago, IL
  • Harmony Healthcare & Rehabilitation Center - Summary/Objective The unit director/coordinator support off-unit activities...
  • 3/28/2024 12:00:00 AM

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Care Coordinator
  • Metta Perspective LLC
  • Niles, IL
  • Job Description Job Description Job description (PLEASE READ TO END IF APPLYING) **Acupuncture and Integrative Medicine ...
  • 3/27/2024 12:00:00 AM

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Patient Care Coordinator
  • Raby Institute for Integrative Medicine
  • Chicago, IL
  • Job Description Job Description Job Description To help ensure the highest customer service to patients and providers th...
  • 3/27/2024 12:00:00 AM

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Primary Care Coordinator
  • VCA Antech, Inc.
  • Aurora, IL
  • Location: 2600 W. Galena Blvd., Aurora, IL 60506 VCA Aurora Animal Hospital's Primary Care team invites you to be our ne...
  • 3/27/2024 12:00:00 AM

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Care Coordinator
  • Haymarket Center
  • Chicago, IL
  • Job Description Job Description WORK DESCRIPTION: Working closely with the medical providers and care coordination team,...
  • 3/26/2024 12:00:00 AM

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Senior Program Manager-Care Coordination
  • Catholic Charities of the Archdiocese of Chicago
  • Chicago, IL
  • Job Description Essential Functions* of the position are detailed below and include any physical requirements checked be...
  • 3/26/2024 12:00:00 AM

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Care Coordinator
  • Cera Care
  • Lincolnshire, IL
  • Position: Care Coordinator Location: Lincolnshire Branch (PE21 8GH) Contract Type: Permanent, Full Time Salary: 24,000 R...
  • 3/26/2024 12:00:00 AM

Tinley Park is a village located in Cook County, Illinois, United States, with a small portion in Will County. The population was 56,703 at the 2010 census. It is one of the fastest growing suburbs south of Chicago. In 2009, Tinley Park was selected by BusinessWeek as the best place to raise a family in America. In 2017, Tinley Park was listed as one of the 50 safest cities in America. Tinley Park is located at 41°34′26″N 87°48′14″W / 41.57389°N 87.80389°W / 41.57389; -87.80389 (41.573800, −87.803891). According to the 2010 census, Tinley Park has a total area of 16.039 square miles (41.54...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$50,721 to $87,048
Tinley Park, Illinois area prices
were up 0.8% from a year ago

Managed Care Coordinator in San Francisco, CA
Care managers also sometimes provide case management--for example, information about transportation assistance, food programs, and other social services.
December 12, 2019
Managed Care Coordinator in Santa Barbara, CA
Nursing home administrators manage staff, admissions, finances, and care of the building, as well as care of the residents in nursing homes.
February 02, 2020
Managed Care Coordinator in Orange, CA
Assist with on-boarding and training of new Managed Care Coordinators.
January 20, 2020