Managed Care Coordinator jobs in Ohio

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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Associate Counsel - Managed Care
  • Cleveland Clinic
  • Beachwood, OH FULL_TIME
  • Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world 


    The Associate Counsel serves as a consultant, legal advisor, advocate, and defender, consistent with the mission, values, and strategic objectives of the organization. This position will negotiate contracts with health insurance payers so we are in-network.  


    The ideal caregiver is someone who:  

    • Is experienced with conflict resolution and problem-solving.  

    Exercises independent judgment and discretion to perform legal services. 

    • Has written and verbal communication skills  

    • Has teamwork and motivational skills.  

    • Has organizational and multitasking skills. 


    This is a rewarding opportunity that offers growth-oriented projects, mentorship, support, and resources. You will experience great exposure to both the institute and department leadership and have numerous opportunities for career growth.


    At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare. 

    Responsibilities:

    • Maintains expertise and advises appropriate department members regarding legal developments within areas of expertise.
    • Actively seeks out opportunities to maintain compliance within those areas of the law.
    • Provides timely responses to requests for legal advice for assigned area.
    • Identifies and implements measures to bring effective legal services to the organization.
    • Collaborates and provides leadership on projects and teams within the Law Department and the organization.
    • Other duties as assigned.

    Education:

    • Juris Doctor (JD) from ABA accredited law school.
    • Knowledge of health insurance contracts, Medicare and Medicaid, nonprofit healthcare, reimbursement, managed care, and value-based care.

    Certifications:

    • Member in good standing of the Ohio bar or ability to become a member of the Ohio bar within a reasonable period of time.

    Complexity of Work:

    • Exercises independent judgment and discretion to perform legal services.
    • Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
    • Must be able to take appropriate action in a stressful environment.

    Work Experience:

    • Two to five years of attorney and/or comparable direct experience in legal specialty required for hire.
    • Experience negotiating agreements/contracts
    • Experience with nonprofit healthcare, reimbursement, managed care, and/or value-based care systems.

    Physical Requirements:

    • Ability to perform work in a stationary position for extended periods.
    • Ability to travel throughout the hospital system.
    • Ability to operate a computer, audio visual and other office equipment.         
    • Ability to communicate and exchange accurate information, including the ability to deliver training in person and virtually.

    Personal Protective Equipment:

    • Follows standard precautions using personal protective equipment as required. 

    Pay Range

    Minimum hourly: $53.90

    Maximum hourly: $82.19

    The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.

  • 18 Days Ago

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Managed Care Nurse Staff
  • Western & Southern Financial Group
  • CINCINNATI, OH FULL_TIME
  • Overview Summary of Responsibilities: Provides concurrent and retrospective utilization reviews, large case management, disability case management and other programs to improve the quality of medical ...
  • Just Posted

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Managed Care Biller
  • CommuniCare Family of Companies
  • Cincinnati, OH FULL_TIME
  • Managed Care BillerDue to Company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.PURPOSE/BELIEF STATEMENTThe positi...
  • 4 Days Ago

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Managed Care Biller
  • CommuniCare Family of Companies
  • Cincinnati, OH FULL_TIME
  • Managed Care BillerDue to Company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.PURPOSE/BELIEF STATEMENTThe positi...
  • 4 Days Ago

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Managed Care Biller
  • CommuniCare Family of Companies
  • Blue, OH FULL_TIME
  • Managed Care BillerDue to Company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.PURPOSE/BELIEF STATEMENTThe positi...
  • 1 Month Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Toledo, OH 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...
  • 1 Month Ago

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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...
  • 4/23/2024 12:00:00 AM

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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, ...
  • 4/23/2024 12:00:00 AM

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Credential and Managed Care Coordinator
  • Us Oncology Network-wide Career Opportunities
  • Norfolk, VA
  • OverviewVirginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Ca...
  • 4/22/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Wilkes Barre, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
  • 4/22/2024 12:00:00 AM

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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) ...
  • 4/20/2024 12:00:00 AM

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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...
  • 4/20/2024 12:00:00 AM

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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

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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

Ohio /oʊˈhaɪoʊ/ (listen) is a Midwestern state in the Great Lakes region of the United States. Of the fifty states, it is the 34th largest by area, the seventh most populous, and the tenth most densely populated. The state's capital and largest city is Columbus. The state takes its name from the Ohio River, whose name in turn originated from the Seneca word ohiːyo', meaning "good river", "great river" or "large creek". Partitioned from the Northwest Territory, Ohio was the 17th state admitted to the Union on March 1, 1803, and the first under the Northwest Ordinance. Ohio is historically know...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$48,177 to $82,678

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