Managed Care Coordinator jobs in Hawaii

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
  • Adventist Health NW
  • Kailua, HI FULL_TIME
  • Adventist Health Castle is the only organization in Hawaii to have received the Baldrige National Quality Award. This award is the highest level of national recognition for performance excellence that a U.

    S. organization can receive.

    Located in Kailua, Adventist Health Castle is a 160-bed hospital and network of eleven community care clinics comprising of dental, primary and specialty care in Kailua, Kaneohe, Kapolei and Laie.

    Adventist Health Castle focuses on providing patient-centered healthcare in a caring environment, close to home, that extends beyond medical center and medical office walls.

    Job Summary :

    Works with multidisciplinary healthcare teams in assigned physician offices settings. Focuses on coaching and coordination of care for designated patients as well as motivating high-risk patient populations to complete wellness screenings as required by individual health plans.

    Works alongside the physicians and office staff to identify needs of patients while assisting the practice to develop a process for managing its patient population.

    Promotes patient-centered care, works side-by-side with physicians and medical home / neighborhood team members, and actively participates in multidisciplinary patient-centered team meetings.

    Job Requirements :

    Education and Work Experience :

    • High School Education / GED or equivalent : Preferred
    • Associate's / Technical Degree or equivalent combination of education / related experience : Preferred
    • Three years' related experience : Preferred

    Essential Functions :

    Assesses patient needs and develops care plans in collaboration with the medical home / neighborhood physicians. Works with insurance companies or other organizations to enroll patients in case management services.

    Serves as liaison between physician offices and other organizations focused on population health initiatives to ensures physicians receive plan of care and status updates on patient progress.

    Works with physician office staff and Patient-Centered Medical Home / Medical Neighborhood physicians to develop standing orders and protocols.

    Reviews data for populations of patients based on insurance company contracts. Creates patient-centered medical home protocols through workflows and patient outreach.

    Monitors patient attribution which is vital to capitated based contracts.

    • Performs all documentation requirements in accordance with established polices and procedures. Tracks and reports via databases on care provided to ensure provider gets reimbursed appropriately for quality performance.
    • Provides patient and caregiver education. Distributes preventative screening education material and makes phone calls to assist with patient outreach.
    • Works collaboratively in a team-based care environment with providers, office staff and other care coordinators. Participates in training and / or cross-training of duties and provides backup coverage.

    Learns programs and provides education for providers to understand programs and measurements and how to implement new workflows.

    Performs other job-related duties as assigned.

    Organizational Requirements :

    Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc.

    as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

    Last updated : 2024-03-08

  • 16 Days Ago

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Managed Care Coordinator, FT, Days
  • Adventist Health
  • Kailua, HI FULL_TIME
  • Located in Kailua, Adventist Health Castle has been one of the area's leading healthcare providers since 1963. We are comprised of a 160-bed hospital, eight medical offices, home care services, urgent...
  • 15 Days Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Honolulu, HI FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
  • 7 Days Ago

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Managed Care Contracts Analyst
  • The Queen's Health System
  • Honolulu, HI FULL_TIME
  • We are, and always will be, dedicated to improving the health of Native Hawaiians and all of the people of Hawai‘i. The Queen’s Health System began with a single hospital in 1859 founded by Queen Emma...
  • 1 Month Ago

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Patient Care Coordinator - KGC
  • Kuakini Geriatric Care, Inc.
  • Honolulu, HI FULL_TIME
  • Title of PositionPatient Care Coordinator - KGCWork HoursRegular Full-TimeKuakini Geriatric Care, Inc.Description of PositionResponsible for coordinating operational activities of a designated unit in...
  • 7 Days Ago

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Care Coordinator
  • Active RPO Solutions Pvt. Ltd.
  • Wailuku, HI FULL_TIME,CONTRACTOR
  • Qualifications  High school diploma or equivalent; additional certification as a Certified Nursing Assistant (CNA) is required.  Proven experience in a patient care setting, preferably in home healt...
  • 18 Days Ago

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Managed Care Coordinator - Referrals
  • Beth Israel Lahey Health
  • Boston, MA
  • When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Job Typ...
  • 3/28/2024 12:00:00 AM

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Managed Care Coordinator
  • Elevance Health
  • Roanoke, VA
  • Anticipated End Date: 2024-04-22 Position Title: Managed Care Coordinator Job Description: Managed Care Coordinator MUST...
  • 3/27/2024 12:00:00 AM

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Managed Care Coordinator
  • MJHS Health System
  • New York, NY
  • Req #: 1509 Job ID: 13084 Job Location(s): New York, NY Zip Code: 10040 Category: Office and Administrative Support Agen...
  • 3/26/2024 12:00:00 AM

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Manager, Care Coordination
  • SCAN
  • Long Beach, CA
  • About SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adult...
  • 3/26/2024 12:00:00 AM

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Manager-Care Coordination
  • St. Catherine of Siena
  • Rockville Centre, NY
  • Overview Manager, Care Coordination (RN), Rockville Centre, NY Explore a career with Mercy Hospital, a 375-bed not-for-p...
  • 3/26/2024 12:00:00 AM

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Manager Care Coordination
  • Crouse Hospital
  • Syracuse, NY
  • Care Coordination is a collaborative practice model including the multidisciplinary health care team, the patient and fa...
  • 3/24/2024 12:00:00 AM

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Manager Care Coordination
  • Catholic Health Services
  • West Islip, NY
  • Overview Manager of Care Coordination (MCC) - Registered Nurse (RN) Are you exceedingly driven, dedicated, and passionat...
  • 3/24/2024 12:00:00 AM

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Utilization Management Care Coordinator
  • Humana, Inc.
  • Clarksville, IN
  • Completes inbound and outbound provider calls to answer UM related questions and prepare authorization request for clini...
  • 3/24/2024 12:00:00 AM

Hawaii (/həˈwaɪi/ (listen) hə-WY-ee; Hawaiian: Hawaiʻi [həˈvɐjʔi]) is the 50th and most recent state to have joined the United States, having received statehood on August 21, 1959. Hawaii is the only U.S. state located in Oceania, the only U.S. state located outside North America, and the only one composed entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean. The state encompasses nearly the entire volcanic Hawaiian archipelago, which comprises hundreds of islands spread over 1,500 miles (2,400 km). At the southea...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$52,054 to $89,335

Managed Care Coordinator in New Orleans, LA
Health systems must meet the operational challenge of managing provider data for thousands of participating providers in their value-based care networks.
January 11, 2020
Managed Care Coordinator in Gainesville, FL
Many telehealth programs give patients easy access to any additional educational materials provided by their health plan or primary care provider.
December 23, 2019
Managed Care Coordinator in Houston, TX
Works with relevant parties to ensure deliverable from all parties are achieved in accordance with strategic timelines.Maintains CHSLI master list of service locations (facility, professional and continuing care)Assists in the resolution of referral, authorization and claims payment issuesSupports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements.
December 27, 2019