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. 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. Typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). Has gained full p ...roficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. Typically requires 5-7 years of related experience.More Show Less
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The Managed Care and Program Compliance Coordinator resolves managed care operational issues such as authorization for services, billing, and claims payment. Ensures all clinical operations comply with Medicaid guidelines and other managed care policies. Maintains managed care contracts and educational information databases. .
About First Responder Health. First Responder Health is dedicated to serving those who serve others. Through our family of companies, we provide comprehensive, proactive, and reactive wellness and resilience resources exclusively for public safety professionals. Our mission is to support first responders in maintaining their mental health and well-being throughout their demanding careers. Our family of companies includes. The Counseling Team Inte...
Anticipated End Date: 2026-02-28 Position Title: Managed Care Coordinator Job Description: Managed Care Coordinator Sign On Bonus-$1000 Location: The locations for this position will be Lynchburg, Roanoke, Pittsylvania, or Halifax Virginia. Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or tr...
About First Responder Health. First Responder Health is dedicated to serving those who serve others. Through our family of companies, we provide comprehensive, proactive, and reactive wellness and resilience resources exclusively for public safety professionals. Our mission is to support first responders in maintaining their mental health and well-being throughout their demanding careers. Our family of companies includes. The Counseling Team Inte...
Sign On Bonus-$1000. Location. The locations for this position will be Lynchburg, Roanoke, Pittsylvania, or Halifax Virginia. Field. This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please ...
Job Description. Location. Corporate Office, Commerce-CA. Position Purpose. The Managed Care Coordinator will collaborate closely with healthcare teams and providers to enhance patient care coordination. Responsibilities include contacting, scheduling, and educating patients on preventive care. Additionally, the Managed Care Coordinator will manage new member outreach, coordinate annual wellness exams, monitor emergency department utilization, an...
Salary. Pay: $18.50 - $23.07 / Hour. Overview. Managed Care Coordinator Overview. . The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. This includes all types of communication (eFax, email, scan documents, phone calls) with case managers to provide concurrent updates as requested by ...
Job description. Our client an established, well-known nonprofit managed healthcare company has an exciting long term temporary managed care coordinator role available. Pay: $22.00 per hour. Possible hybrid role (pending training). Performance Standard. Receives Care Plan minutes from CM and uploads within 2 business days into Guiding Care as “Case Conference” notes. Creates outpatient authorization shells in Guiding Care and sends activity to CM...
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, i...
Key Responsibilities. Implement initial credentialing and re-credentialing functions for employed and contracted practitioners. This would include obtaining Medicare, Medicaid and NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites. Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications. Maintain timely and accurate practitioner insurance pla...
Key Responsibilities. Implement initial credentialing and re-credentialing functions for employed and contracted practitioners. This would include obtaining Medicare, Medicaid and NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites. Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications. Maintain timely and accurate practitioner insurance pla...
Key Responsibilities. Implement initial credentialing and re-credentialing functions for employed and contracted practitioners. This would include obtaining Medicare, Medicaid and NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites. Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications. Maintain timely and accurate practitioner insurance pla...
