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)
The Managed Care Coordinator completes insurance requirements and provides case management as needed for services performed in various patient seeing settings. The individual obtains and provides insurance benefit information to patients and patient care departments. The Managed Care Coordinator assists patients and providers with developing strategies for alternative options for non-covered services by communicating with the provider, patient, insurance carrier and Patient Assistance Counselor.
JOB QUALIFICATIONSÂ
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: High school diploma or equivalent. Successful completion of a medical terminology and an anatomy & physiology course, per departmental procedures, within one year of hire.
Preferred/Optional: Successful completion of a medical terminology and an anatomy & physiology course at time of hire. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program.
EXPERIENCE
Minimum Required: Two years’ experience in a medical business office or health care setting. Prior experience should include working with and obtaining insurance eligibility and benefit information.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: For positions hired within the dental centers: Basic Life Support (BLS) awarded by the American Heart Association within one year of hire.
Preferred/Optional: Basic Life Support (BLS) awarded by the American Heart Association at time of hire.