Managed Care Coordinator jobs in New Mexico
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)
Recently Added Managed Care Coordinator jobs
Credential and Managed Care Coordinator
- Nexus Health
-
Santa Fe, NM
FULL_TIME
-
Overview:SCOPE:
Under direct supervision, maintains and coordinates actions for provider credentialing, licensure, and hospital privileges activities. Provides administrative support to state/practice managed care functions, which may include provider plan participation and credentialing, contract, files, explanation of benefits (EOB) analysis and managed care reporting. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
Responsibilities:ESSENTIAL DUTIES AND RESPONSIBILITIES:
Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments.
Updates and maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers.
Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
Sets-up and maintains the contract management system to include terms of the contract, providers credentialed to the payor and other contracted service providers (labs, hospitals).
Maintains contract filing systems.
May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payors according to policy and procedure. May produce monthly managed care reports and implements new analysis tools to assist in reporting functions.
May maintain expected reimbursement by CPT code for the top payor contracts in each market and communicate changes to system librarian.
Supports Network Contracting Representative/Manager in general administrative functions.
Other duties as requested or assigned.
MINIMUM QUALIFICATIONS:
High school diploma or equivalent required. Some physician credentialing and/or managed care support experience preferred.
PHYSICAL DEMANDS:
The physical demands described here 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.
While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
COMPETENCIES:
Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
Demonstrates Adaptability: Handles Day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, Job Profile Summary processes, and service against those standards; manages quality; improves efficiencies.
Qualifications:WORK ENVIRONMENT:
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. - 29 Days Ago
Credential and Managed Care Coordinator
- US Oncology Network-wide Career Opportunities
-
Santa Fe, NM
FULL_TIME
- OverviewSCOPE:Under direct supervision, maintains and coordinates actions for provider credentialing, licensure, and hospital privileges activities. Provides administrative support to state/practice m...
- 22 Days Ago
PBM / Managed Care Pharmacist
- Pharmacy Careers
-
Albuquerque, NM
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...
- 25 Days Ago
Connected Care Coordinator
- Duke City Urgent Care
-
Cedar, NM
FULL_TIME
- Salary: $16 - 20 - Per hour Job Description: Duke City Primary Care is looking to add a few exceptional Connected Care Coordinators (CCC) individuals for our Cedar Crest and Albuquerque locations. At ...
- 19 Days Ago
Patient Care Coordinator
- Otto Bock Patient Care, LLC
-
Santa Fe, NM
FULL_TIME
- Business Unit: Otto Bock Patient Care, LLC Location: Santa Fe, NM, US Contract Type: regular Scope of employment: full-time Contact Person: Lisa Castro Contact Information: Job ID: 6763 Summary Statem...
- 1 Month Ago
Member Care Coordinator - Taos, NM
- Health Care Service Corp.
-
Albuquerque, NM
FULL_TIME
- At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning p...
- 15 Days Ago
Managed Care Coordinator jobs at Popular Companies
Case Manager (Care Coordinator)
- Pacifica Hospital of the Valley
-
Los Angeles, CA
- Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
- 4/19/2024 12:00:00 AM
Managed Care Coordinator - Referrals
- Beth Israel Lahey Health
-
Plymouth, MA
- **When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.** **Job...
- 4/19/2024 12:00:00 AM
Case Manager/Care Coordination Consultant
- Boys Town
-
West Palm Beach, FL
- Provides intensive and professional case management services to youth utilizing a strength based and comprehensive model...
- 4/19/2024 12:00:00 AM
Manager Care Coordination
- hireneXus Research
-
San Francisco, CA
- Manager Care Coordination Population Health San Francisco Bay Area Here are some of the benefits our client offers! HUGE...
- 4/18/2024 12:00:00 AM
Manager Care Coordination
- Crouse Hospital
-
Syracuse, NY
- Care Coordination is a collaborative practice model including the multidisciplinary health care team, the patient and fa...
- 4/18/2024 12:00:00 AM
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...
- 4/18/2024 12:00:00 AM
office manager/ care coordinator
- 5 Stars Home Care LLC
-
Alexandria, VA
- Job Description Job Description Job Summary: Duties: Responsible for all areas of Operations; human resources, intakes, ...
- 4/18/2024 12:00:00 AM
Case Manager (Care Coordinator)
- Pacifica Hospital of the Valley
-
Los Angeles, CA
- Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
- 4/15/2024 12:00:00 AM
About New Mexico
New Mexico (Spanish: Nuevo México Spanish pronunciation: [ˈnweβo ˈmexiko] (listen), Navajo: Yootó Hahoodzo pronounced [jòːtxó xɑ̀xʷòːtsò]) is a state in the Southwestern region of the United States of America; its capital and cultural center is Santa Fe, which was founded in 1610 as capital of Nuevo México (itself established as a province of New Spain in 1598), while its largest city is Albuquerque with its accompanying metropolitan area. It is one of the Mountain States and shares the Four Corners region with Utah, Colorado, and Arizona; its other neighboring states are Oklahoma to the north...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$45,418 to $77,944
Most Popular Cities in New Mexico for Managed Care Coordinator Jobs
What does a Managed Care Coordinator do?
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