Managed Care Coordinator jobs in New Mexico

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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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Albuquerque, NM 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 medication utilization, formulary management, and ensuring cost-effective pharmacy services. The ideal candidate will bring a deep understanding of managed care principles, a proactive approach to problem-solving, and a commitment to optimizing pharmacy outcomes within a managed care environment.

    Preferred Qualifications:
    PharmD degree from an accredited pharmacy program
    Previous experience in Pharmacy Benefit Management (PBM) or Managed Care
    Knowledge of formulary development and management
    State pharmacy license in good standing
    Strong analytical and data interpretation skills
    Excellent communication and negotiation abilities
    Familiarity with healthcare regulations and compliance standards
    Collaboration experience with healthcare providers, payers, and pharmaceutical manufacturers
    Proficiency in utilizing pharmacy management software and tools
    Active participation in relevant professional organizations
    Dedication to staying informed about industry trends and innovations

    Responsibilities:
    Collaborate with healthcare stakeholders to implement and optimize pharmacy benefit programs
    Conduct formulary reviews and assessments to ensure cost-effective and evidence-based medication choices
    Monitor and analyze pharmacy utilization trends, identifying opportunities for cost savings and improved patient outcomes
    Provide expertise in drug utilization management and prior authorization processes
    Stay informed about industry regulations, guidelines, and emerging trends in managed care pharmacy
    If you are a passionate and experienced pharmacist with a background in PBM or Managed Care, we invite you to join our dynamic team dedicated to advancing healthcare through innovative and cost-effective pharmacy solutions. Apply now to contribute to the future of managed care pharmacy.
  • 8 Days Ago

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Director of Managed Care & Contracting
  • HME Specialists LLC
  • Albuquerque, NM FULL_TIME
  • About the job HME Specialists is a fast growing primary player in NM providing Durable Medical Equipment, Home Infusion and LTC/Hospice services The Director of Managed Care & Contracting will oversee...
  • 2 Months Ago

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Director of Managed Care & Contracting
  • HME Specialists LLC
  • Albuquerque, NM FULL_TIME
  • About the job HME Specialists is a fast growing primary player in NM providing Durable Medical Equipment, Home Infusion and LTC/Hospice services The Director of Managed Care & Contracting will oversee...
  • 2 Months Ago

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Managed Care Provider Relations Specialist
  • UNM Medical Group
  • Albuquerque, NM FULL_TIME
  • UNM Medical Group, Inc is hiring a Provider Relations Specialist to join our Office of Managed Care and Clinical Contract Services Team. This busy and passionate team is looking for a highly motivated...
  • 2 Months Ago

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Managed Care Provider Relations Specialist
  • UNM Medical Group
  • Albuquerque, NM FULL_TIME
  • UNM Medical Group, Inc is hiring a Provider Relations Specialist to join our Office of Managed Care and Clinical Contract Services Team. This busy and passionate team is looking for a highly motivated...
  • 2 Months Ago

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Remote Bilingual Care Coordinator
  • Chronic Care Staffing
  • , NM FULL_TIME
  • **Working Hours: 8:00am - 5:00pm PST** Job description Chronic Care Staffing is a nationwide provider of remote patient health services strictly following CMS service guidelines. We work with an array...
  • 29 Days Ago

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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, ...
  • 6/2/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Stillwater, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
  • 6/1/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Picture Rocks, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Danville, Pennsylvania Job Category: RN - Re...
  • 6/1/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Lake Winola, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
  • 6/1/2024 12:00:00 AM

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Managed Care Coordinator
  • The Jacobson Group
  • Pennington, NJ
  • Job Description Job Description Job Summary: This position supports the Health Services and Utilization Management funct...
  • 5/31/2024 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) ...
  • 5/30/2024 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) ...
  • 5/29/2024 12:00:00 AM

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Credentialing and Managed Care Coordinator
  • Texas Oncology
  • Richardson, TX
  • Overview: The US Oncology Network is looking for a Credentialing and Managed Care Coordinator to join our team at Texas ...
  • 5/29/2024 12:00:00 AM

New Mexico (Spanish: Nuevo México Spanish pronunciation: [ˈnweβo ˈmexiko] (listen), Navajo: Yootó Hahoodzo pronounced [jòːtxó xɑ̀xʷòːtsò]) is a state in the Southwestern region of the United States of America; its capital and cultural center is Santa Fe, which was founded in 1610 as capital of Nuevo México (itself established as a province of New Spain in 1598), while its largest city is Albuquerque with its accompanying metropolitan area. It is one of the Mountain States and shares the Four Corners region with Utah, Colorado, and Arizona; its other neighboring states are Oklahoma to the north...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$45,505 to $78,095

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