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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Overview. Employment Type. Full Time. In-Office Position. Benefits. M/D/V, Life Ins., 401(k), PTO, Paid Holidays. Evansville, IN. JOB SCOPE. Under general supervision, provides administrative support to managed care function by auditing and maintaining managed care contract requirements in computer system, running standard reports, resolving contract errors, and answering routine contract questions. Processes provider credentialing and licensure ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Responsibilities. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of struc...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Responsibilities. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of struc...
Position Summary. Responsible for implementing, operationalizing and administration of third-party payor / Managed Care agreements within all market segments for McLaren Physician Partners (MPP), McLaren Health Care Corporation (MHCC), McLaren High Performance Network (MHPN) and its subsidiaries. Assist and support of the relationships with Health Plans and third-party payors.Coordinate and facilitate education of hospitals, physicians and staff ...
Position Summary. Responsible for implementing, operationalizing and administration of third-party payor / Managed Care agreements within all market segments for McLaren Physician Partners (MPP), McLaren Health Care Corporation (MHCC), McLaren High Performance Network (MHPN) and its subsidiaries. Assist and support of the relationships with Health Plans and third-party payors.Coordinate and facilitate education of hospitals, physicians and staff ...
We are currently seeking qualified candidates for a full time Managed Care Coordinator position in the Beaumont area. Job Description. This position will coordinate with Insurance companies, providers, patients, and clinical staff. This position will also comply with governmental regulations for the health care industry, help with daily operations, assisting Doctors, patients and staff. Qualifications. Licensed as a LVN in the State of Texas or a...
Job Summary: We are seeking a highly organized and detail-oriented individual to join our team as a Patient Care Coordinator. As a Patient Care Coordinator, you will play a crucial role in providing administrative support and ensuring the smooth operation of our medical office or dental office. Responsibilities: - Greet and check-in patients, ensuring a positive and welcoming experience - Schedule appointments and manage the appointment calendar ...
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...
POSITION OVERVIEW. The. Managed Care Coordinator. is responsible for the day-to-day functions of collaborative communication with external case managers at referring provider facilities and/or managed care organizations (MCO) for data collection, interpretation, and certification/recertification from third party payers at pre-admission through discharge, ongoing medical necessity reviews and interdisciplinary team support with respect to MCO requ...
Job Description. Job Description. 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 communica...
Why work for MJHS. When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now. No. You will here. You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patien...
