Managed Care Coordinator jobs in Kentucky
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
Senior Director Managed Care Contracting
- ScionHealth
-
Louisville, KY
CONTRACTOR
-
Description
ScionHealth is recruiting for a Senior Director, Managed Care, to join our team! Qualified remote candidates will be considered for this role.
Job Summary
The Senior Director, Managed Care leads negotiation of managed care Payor agreements between ScionHealth and various payer organizations. This includes but is not limited to the negotiation of Commercial, Medicare, and Medicaid products for both Hospital and Physician practices. The position works in conjunction with Community Hospitals, Physician Services and Division Leadership as well as Revenue Cycle to support ScionHealth’s overall managed care and operational strategies.
These duties are performed while operating within the established budgetary and business guidelines in coordination with the VP of Managed Care and the leaders of the Community Hospital Division.
Essential Functions- Participates in strategic planning, development, and enhancement of revenue of managed care contracts.
- Plans and develops financial plans, including budgets, revenue projections for Managed Care contracts.
- Directs the coordination and integration of managed care services with other departments and the primary functions of their market facilities.
- Provides for orientation, in-service training, continuing education, annual performance, and competency reviews of managed care personnel to ensure staff is competent to provide services.
- Gives direction to the Physician Managed Care Contracting.
- Responsible for all Managed Care contract negotiation and execution, team building, and company managed care marketing initiatives.
- Oversees and participates in the development, negotiation, implementation, monitoring, and management of all assigned managed care agreements.
- Evaluates and recommends financial parameters and reimbursement methodologies.
- Implements new managed care programs in conjunction with faculty, staff, and hospital/practice administration. Keeps staff apprised of developments in the managed care marketplace.
- Directs and participates in financial analysis of revenue projections based on contractual rates with payers, adverse trends, terms and appropriate recommendations or conclusions.
- Analyze and monitor financial aspects of existing managed care contracts. Utilize analysis for feedback on contract renewals, renegotiations, or termination. Make recommendations regarding participation or non-participation with new or existing agreements.
- Facilitates promotion of departmental programs to provider networks.
- Develop and audit payer fee schedules based on negotiated reimbursement rates by contract and/or product line.
- Maintain and distribute participation information by payer by network product for all signed contracts, contracts under-negotiation, or plans not being negotiated.
- Responsible for reviewing managed care legal contract language and negotiating language to meet agreed to parameters with legal counsel to lessen risk and improve operational efficiencies.
- Strategic planning accountability for other reimbursement & profitability endeavors with subcontract agreements, government programs, pay for performance initiatives.
- Assembles information and prepares materials for presentation to committees, administrators, and managed care networks.
- Perform special projects as requested by the Vice President, Managed Care.
- Liaison with physician practices, hospitals, other affiliated organizations, and managed care organizations regarding issues pertaining to managed care.
- Initiate contact with Managed Care Plans to begin negotiation/re-negotiation process.
- Work with the Revenue Cycle as needed to establish negotiating position.
- Coordinate with Revenue Cycle Groups to ensure contract compliance and troubleshoot reimbursement issues.
- Coordinate Physician contracting with hospital and ancillary agreements.
- Self-motivated and results oriented.
- Ability to apply knowledge of medical terminology and payor reimbursement methodologies including managed care requirements and strategies.
- Strong organizational skills.
- Excellent oral and written communication and interpersonal skills.
- Ability to communicate in English effectively through verbal and written means.
- Ability to work under stress with conflicting priorities and deadlines.
- Ability to think critically.
- Ability to review and understand contract language.
- Ability to make presentations.
- Ability to conduct negotiations.
- Computer skills including Microsoft Office software.
- Ability to travel approximately 20% of the time.
Education- Bachelor’s degree in business or related field or relevant work experience required; Master’s degree preferred.
- Minimum ten years’ healthcare experience, including at least eight years’ experience in healthcare managed care.
- A minimum of six years' experience in negotiating hospitals and physicians managed care agreements required.
- Clinical and medical technology knowledge.
- Computer skills – Proficient in Word/Excel/PowerPoint.
- 2 Days Ago
Senior Director Managed Care Contracting
- ScionHealth Corporate Support Center
-
Louisville, KY
OTHER
- DescriptionScionHealth is recruiting for a Senior Director, Managed Care, to join our team! Qualified remote candidates will be considered for this role. Job Summary The Senior Director, Managed Care ...
- 4 Days Ago
Senior Director Managed Care Contracting
- Kindred Healthcare Inc.
-
Louisville, KY
OTHER
- ScionHealth is recruiting for a Senior Director, Managed Care, to join our team! Qualified remote candidates will be considered for this role.Job SummaryThe Senior Director, Managed Care leads negotia...
- Just Posted
Patient Care Coordinator
- Horizon Adult Health Care
-
Lexington, KY
FULL_TIME
- Horizon Adult Health Care in Lexington, KY, an EOE, has the following job opportunity available: Patient Care Coordinator The position is full time, daytime hours, Monday-Friday. The position will req...
- 4 Days Ago
Patient Care Coordinator
- Horizon Adult Health Care
-
Irvine, KY
FULL_TIME
- Horizon Adult Health Care in Irvine, KY, an EOE, has the following job opportunity available: Patient Care Coordinator The position is full time, daytime hours, Monday-Friday. The position will requir...
- 12 Days Ago
CHRONIC CARE COORDINATOR
- Abode Care Partners
-
LOUISVILLE, KY
FULL_TIME
- Our Company Abode Care Partners Overview The Chronic Care Coordinator will use their health care experience, talents, and problem-solving skills to work independently and manage a monthly allocation o...
- 2 Months Ago
Managed Care Coordinator jobs at Popular Companies
Managed Care Coordinator
- Mindlance
-
Columbia, SC
- Job Title: Managed Care Coordinator Job Location: Columbia, SC Top 3/5 Skills: · RN / Registered Nurse License · Chronic...
- 6/11/2024 12:00:00 AM
Managed Care Coordinator-Onsite Kansas City
- AdventHealth
-
Maitland, FL
- **AdventHealth -** **This position is in Kansas City** **All the benefits and perks you need for you and your family:** ...
- 6/10/2024 12:00:00 AM
Care Management, Care Coordinator, Utilization Management
- Hackensack Meridian Health
-
Neptune, NJ
- Description: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients ...
- 6/10/2024 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
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
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 ...
- 6/8/2024 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
About Kentucky
Kentucky (/kənˈtʌki/ (listen) kən-TUK-ee), officially the Commonwealth of Kentucky, is a state located in the east south-central region of the United States. Although styled as the "State of Kentucky" in the law creating it, (because in Kentucky's first constitution, the name state was used) Kentucky is one of four U.S. states constituted as a commonwealth (the others being Virginia, Pennsylvania, and Massachusetts). Originally a part of Virginia, in 1792 Kentucky became the 15th state to join the Union. Kentucky is the 37th most extensive and the 26th most populous of the 50 United States.
Ke...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$46,537 to $79,868
Most Popular Cities in Kentucky 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