Managed Care Coordinator jobs in Rhode Island

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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Outpatient Managed Care Coordinator Per Diem
  • Care New England
  • Providence, RI PER_DIEM
  • Responsibilities:

    Patient Benefit Verification Information: Ensures accurate completion of benefit verification of all new patient insurance information and authorization in accordance with State and Federal regulations, individual requirements and Hospital policies and procedures.

    Insurance Referral & Authorization Requirements: Responsible for obtaining required authorizations and/or referrals for all new outpatients scheduled by OP intake coordinators and physician admins for existing and new outpatient program visits

    Patient Financial Responsibility: Reviews/obtains insurance co-payment information from third party payers for accuracy. Communicates co-payment and deductible information to Outpatient Receptionists, PBO and Patients.

    Requirements:

    Education: High School Diploma

    Training and Experience: Benefit verification 2 to 4 years exp,

    Special Qualifications: Systems: Epic, Cerner preferred but not required

    Applicants MUST have strong knowledge and experience with insurance benefit interpretation, interacting with insurance companies, etc.

    Schedule: Per Diem Union position


    Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

    EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

    Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.

    Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

  • 25 Days Ago

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Outpatient Managed Care Coordinator Per Diem
  • Butler Hospital
  • Providence, RI PER_DIEM
  • Responsibilities: Patient Benefit Verification Information: Ensures accurate completion of benefit verification of all new patient insurance information and authorization in accordance with State and ...
  • 25 Days Ago

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Coordinator II - Community Health Worker
  • Managed Staffing, Inc.
  • Woonsocket, RI FULL_TIME
  • THIS IS A SAFETY COMPLIANT ROLE - fully WFHWhen submitting candidate please indicate which position/location they would like to be considered for.Position 2-Zip Codes: 60620, 60619, 60617, 60621Commun...
  • 7 Days Ago

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P D D H Clinical Care Coordinator
  • Care New England
  • Providence, RI FULL_TIME
  • Job Summary: The PDDH Care Coordinator performs psycho-therapeutic evaluations, provides direct clinical services, and assesses on-going needs of patients and their families in the Post Partum Disorde...
  • 2 Months Ago

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Material Handler
  • Managed Staffing
  • Warwick, RI CONTRACTOR
  • Duties in this position are usually repetitive, requiring limited analysis and use of individual judgment. Specific duties for this position include scanning trays to prepare invoices, matching invoic...
  • 20 Days Ago

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MDS Coordinator (LPN or RN)
  • Aperion Care
  • Providence, RI FULL_TIME
  • Come join the talented staff at AdviniaCare! We’re seeking a skilled and experienced MDS Coordinator (LPN or RN). Great work life balance, comprehensive benefits and competitive salary offered. We are...
  • 9 Days Ago

Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$51,630 to $88,611

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