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)
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 :
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.
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