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)
This position works in collaboration with the Vice President of Contracting and Senior Director of Payor Relations to assist with all aspects of managed care operations including contract negotiation, contract payment modeling, and contract implementation. This position acts as a liaison between Payor Relations and other internal and external entities to create seamless operational managed care performance along with maximizing payor contracting terms. The individual will be responsible for high-level, sophisticated reporting, modeling, and analyses using both hospital and professional claims data. This employee adeptly collaborates with management, operations, and administrative support teams to efficiently undertake the necessary steps crucial for successful contract negotiations. This position will make sure that negotiations are handled efficiently to meet important deadlines and remain within approved financial parameters.