Managed Care Coordinator jobs in North Carolina

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 Analyst / Managed Care / Full-Time
  • Catawba
  • Claremont, NC FULL_TIME
  • Summary: 


     
    Position is responsible for working with various internal and external customers regarding contract payor terms, policy/procedure updates, payor administration, variances/contract modifications, pricing updates, as well as anything that has an operational impact on the organization.  Strong analytical skills needed to compile and analyze data including: managed care denials/underpayment/ overpayment identification and resolution, contract modeling and evaluation, filing appeals as well as aiding in decision support reporting.  This position is responsible for day-to-day oversight of the contract compliance, payor relationships, co-ordination of payer onsite meetings and cross training with Provider Enrollment Specialist for credentialing and re-credentialing duties. Must work within contract language and have an understanding of healthcare reimbursement methodologies and language.  Majority of time will be spent working within Microsoft Excel, performing data analysis, tracking, trending and research.  Will also work with Contract Modeling software. 

     
    Required Education: 

     
    Associate’s degree from an accredited college or a minimum of four years’ experience with managed care contracting or payor relations. 

     
    Required Work Experience: 

     
    One year of applicable experience, if candidate has no experience they must have completed a successful healthcare or finance oriented internship with good references or an extensive managed care or an analytical background.  
  • 11 Days Ago

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Director Managed Care Contracting
  • ECU Health
  • Greenville, NC FULL_TIME
  • ECU Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system ...
  • 22 Days Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Charlotte, NC 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...
  • 4 Days Ago

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Manager - Managed Care Contracting
  • Candidate Experience site
  • Charlotte, NC FULL_TIME
  • Job Summary Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract lang...
  • 1 Month Ago

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HCS Executive Director Managed Care
  • UNC Health Careers
  • Morrisville, NC FULL_TIME
  • Description Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.Job Summary:The System...
  • 19 Days Ago

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Provider Operations Managed Care Consultant
  • North Carolina Dept of Health and Human Services
  • UNKNOWN, NC FULL_TIME
  • Description of Work **This position is exempt from the State Human Resources Act** TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Departme...
  • 3 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

North Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the southeastern region of the United States. It borders South Carolina and Georgia to the south, Tennessee to the west, Virginia to the north, and the Atlantic Ocean to the east. North Carolina is the 28th-most extensive and the 9th-most populous of the U.S. states. The state is divided into 100 counties. The capital is Raleigh, which along with Durham and Chapel Hill is home to the largest research park in the United States (Research Triangle Park). The most populous municipality is Charlotte, which is the second-largest banking center in...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$47,628 to $81,740

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