Managed Care Finance Director directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Being a Managed Care Finance Director implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Additionally, Managed Care Finance Director typically reports to top management. The Managed Care Finance Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Managed Care Finance Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Job Summary: The Coordinator-Managed Care works under the supervision of Manager Managed Care. Provides LLEAP Tapestry training to LLUHC Departments. Tracks Bed Day activity, admits, discharges, and Emergency Room services. Approves referral requests within the scope of position, according to health plan criteria and health plan benefit. Arranges for approved home services. Prepares all utilization management (UM) reports. Communicates with out of network facilities. Prepares data required for UM Audits. Cross covers all key areas of utilization management to ensure compliance with regulations. Performs other duties as needed.
Education and Experience: Minimum five years of managed care experience either with a medical group or a managed care organization, with three years focused in utilization management, health plan criteria and benefit interpretation, authorization determination, and all aspects of health plan UM audits required. Must attain a status of LLEAP Tapestry Credentialed Trainer (CT) status within 90 days of starting position, and maintain.
Knowledge and Skills: Knowledge of medical terminology, medical diagnosis and diagnostic procedures required. Knowledge of healthcare regulatory requirements; thorough understanding of all aspects of the current managed care environment. Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications: None
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