Managed Care Coordinator jobs in Maine
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
RPM Care Coordinator RN
- Penobscot Community Health Care
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Hampden, ME
FULL_TIME
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PCHC’s Care Management team is looking for a Remote Patient Monitoring (RPM) Care Coordinator RN! In this innovative and forward-facing role, you’ll collaborate to track and compare RMP activities and services across the care continuum. You’ll develop and foster trusting professional relationships with internal and external partners, collaborating to achieve optimal patient outcomes. We’re looking for a resourceful RN who is skilled in advocacy and communication, and who is ready to make a positive impact. Sound like you? Apply today!
What’s it like to work at PCHC? Find out: https://www.youtube.com/watch?v=GyC3DFYq0zg
Schedule: Full-Time, Monday-Friday, 8am-4:30pm (Candidate must be able to train and onboarding in Bangor, Maine for the first 6 months of employment. Hybrid remote schedule possible after the 6-month training period and depending on the needs of the Care Management department. Candidate must be eligible per PCHC’s Telecommuting policy.)
Highlights of the position:- Demonstrates professionalism, collaboration, and excellent communication and follow-through skills.
- Tracks and compares RMP activities and services being utilized across the care continuum. Reports differences and provides feedback to leadership as appropriate.
- Educates patients on the frequency and use of their assigned in-home monitoring devices. Partners with each patient to create a personalized, comprehensive care plan via in-person, phone, or virtually.
- Collaborates internally and externally to ensure successful management of remote monitoring activities. Establishes a meaningful rapport that builds trust, open communication, and motivation to make a positive change in the patient's health.
- Reviews patient data from designated RPM portal systems, documents in the EMR, and communicates with the care team as appropriate. Follows appropriate communication protocols and workflows to escalate concerning readings and/or symptoms to the provider.
- Follows established protocols to identify, communicate, and document device trends and any associated symptoms in the patient's medical record. Collaborates to identify appropriate patients for remote monitoring and care management, utilizing established criteria.
- Maintains a solid working knowledge of payer requirements. Develops collaborative professional relationships with insurance case managers and negotiates on behalf of patients to ensure cost-effective, high-quality services, and to maximize the efficient use of resources.
- Federally Qualified Health Center offering integrated Medical Home Model
- Collegial professional atmosphere with informed leadership
- Flexible schedules supportive of work/life balance
- Competitive compensation and generous benefits
- PCHC cares for the WHOLE person, offering a broad range of services, including Psychiatry & Mental Health, Dental, Family Medicine, Pediatrics, Pharmacy, Geriatrics, Lab & X-Ray, Physical Therapy and Podiatry all within one organization.
- Must have a valid RN degree with an active, unrestricted license in Maine or a state that is part of the Nurse Licensure Compact.
- At least five years of experience in adult or primary care health care setting required, with involvement in managing chronic health conditions.
- At least three years of experience in working with healthcare programs or projects required, with experience in population management, health coaching, or care management preferred.
- Will have up-to-date training and certification in Healthcare Provider Basic Life Support issued by American Heart Association, American Red Cross, or American Health & Safety Institute. Must obtain within 2 weeks if not current at hire.
- Having a valid driver’s license with an acceptable driving record and/or an appropriate length of driving experience for insurance purposes is required. Any concerns raised by the results of a driving record check will be subject to an individualized review to determine whether the infraction is relevant to the individual’s ability to perform the responsibilities of the position in accordance with PCHC’s Automobile Safety and Background Check Policy.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or any other characteristic protected by law.
- 4 Days Ago
RN-Resident Health and Care Services Coordinator
- Woodlands Memory Care of Lewiston
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Lewiston, ME
FULL_TIME
- DescriptionDo you have a passion for working with senior citizens and a collaborative mindset that values teamwork? Are you an exceptional nurse who brings a touch of empathy to healthcare while appro...
- 15 Days Ago
Care Coordinator
- Clarvida
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Ellsworth, ME
FULL_TIME
- About this role Our Care Coordinator provides Targeted Case Management (TCM) and Behavioral Health Home (BHH) services to children and adults with a behavioral or mental health diagnosis. You will mee...
- 6 Days Ago
Care Coordinator
- Sweetser
-
Sanford, ME
FULL_TIME
- Becoming part of the Sweetser family means you can make a difference in the lives of Maine children, adults, and families every day. As a nationally recognized and accredited leader, we offer competit...
- 9 Days Ago
Care Coordinator
- Mount Desert Island Hospital
-
Bar Harbor, ME
FULL_TIME
- Description Summary: The RN Care Coordinator functions within the full scope of nursing practice to coordinate patient care across the continuum of care (inpatient/outpatient/community). Coordinates t...
- 10 Days Ago
Care coordinator
- Pathways Health and Community Support, LLC.
-
Ellsworth, ME
FULL_TIME
- Description About this role Our Care Coordinator provides Targeted Case Management (TCM) and Behavioral Health Home (BHH) services to children and adults with a behavioral or mental health diagnosis. ...
- 10 Days Ago
Managed Care Coordinator jobs at Popular Companies
Managed Care Coordinator
- MJHS
-
New York, NY
- Req #: 1509 Job ID: 13084 Job Location: New York, NY Zip Code: 10040 Category: Office and Administrative Support Agency:...
- 6/10/2024 12:00:00 AM
Sales Manager/ Care Coordinator
- Always Best Care Senior Services
-
Thousand Oaks, CA
- Sales Manager / Care Coordinator Always Best Care, a National home care company, is currently looking for a seasoned, en...
- 6/9/2024 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) ...
- 6/9/2024 12:00:00 AM
Managed Care Coordinator - Foster Care
- Elevance Health
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Radford, VA
- Description The Foster Care Managed Case Manager is responsible for overall management of member's individual service pl...
- 6/9/2024 12:00:00 AM
Managed Care Coordinator - Foster Care
- Elevance Health
-
Norfolk, VA
- Description The Foster Care Managed Case Manager is responsible for overall management of member's individual service pl...
- 6/9/2024 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) ...
- 6/8/2024 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, ...
- 6/7/2024 12:00:00 AM
Managed Care Coordinator
- Mindlance
-
Columbia, SC
- Job Title: Managed Care Coordinator Job Location: Columbia, SC Top 3/5 Skills: · RN / Registered Nurse License · Chronic...
- 6/6/2024 12:00:00 AM
About Maine
To the south and east is the Atlantic Ocean and to the north and northeast is New Brunswick, a province of Canada. The Canadian province of Quebec is to the northwest. Maine is both the northernmost state in New England and the largest, accounting for almost half of the region's entire land area. Maine is the only state in the continental US to border only one other American state (New Hampshire to the South and West).
Maine is the easternmost state in the United States in both its extreme points and its geographic center. The town of Lubec is the easternmost organized settlement in the United...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$48,119 to $82,584
Most Popular Cities in Maine 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