Managed Care Coordinator

Managed Care Coordinator Overview

• The Managed Care Coordinator role ensures members receive timely, high-quality services through efficient care coordination and authorization processes.
• Support Medicare and Medicaid members by maintaining accurate records and tracking hospital admissions and discharges.
• Collaborate with providers and vendors to coordinate necessary services and ensure compliance with regulatory standards.
• Provide critical support to clinical staff by routing cases and facilitating care management activities.
• Utilize healthcare operations and customer service skills to enhance member satisfaction and care outcomes.
• Hybrid work arrangement offers flexibility with two days in-office weekly.
• Temporary six-month contract role provides coverage during employee leave of absence.
• Opportunity to work in a dynamic healthcare environment with interdisciplinary teams.

Managed Care Coordinator Key Responsibilities & Duties

• Process preauthorization requests and inquiries, ensuring timely and accurate service determination.
• Coordinate vendor communications and authorizations, adhering to established workflows and timeframes.
• Maintain accurate data entry for service authorizations and member records with minimal error rates.
• Track inpatient admissions and discharges, verifying eligibility and routing information to case managers.
• Research and update team files, ensuring integrity and compliance with departmental processes.
• Collaborate with interdisciplinary teams to address member needs and recommend alternative care levels.
• Handle confidential information with professionalism and maintain collegial relationships within the team.
• Support regulatory compliance and organizational goals through efficient resource allocation and prioritization.

Managed Care Coordinator Job Requirements

• High School Diploma or equivalent required; college degree preferred.
• Minimum two years of healthcare experience, with managed care or care coordination background preferred.
• Familiarity with medical terminology, utilization management, and case management processes.
• Proficient in written and oral communication, with strong analytical and organizational skills.
• Ability to work independently, prioritize tasks, and maintain confidentiality.
• Experience collaborating in interdisciplinary healthcare teams and maintaining collegial relationships.
• Knowledge of Medicare and Medicaid regulations and care coordination practices.
• Empathy and understanding in handling member needs and recommending care alternatives.