Managed Care Coordinator

Managed Care Coordinator Overview

• The Managed Care Coordinator ensures members receive timely, appropriate services by processing authorizations and coordinating with providers and vendors.
• This role involves tracking hospital admissions and discharges while maintaining accurate member records and routing cases to clinical staff when necessary.
• Supports high-quality, cost-effective care for Medicare and Medicaid members through effective care coordination and healthcare operations.
• Provides coverage for employees on leave, ensuring continuity in managed care operations and member services.
• Hybrid work arrangement with two days per week in the office, offering flexibility and collaboration opportunities.
• Temporary six-month contract position with potential for impactful contributions to healthcare service delivery.
• Ideal for candidates with previous healthcare experience, particularly in care coordination or management roles.
• Opportunity to work with interdisciplinary teams to enhance member care and operational efficiency.

Managed Care Coordinator Key Responsibilities & Duties

• Process initial requests and inquiries for preauthorization of services and supplies, ensuring compliance with regulatory guidelines.
• Coordinate communication and authorization with vendors, processing requests within established timeframes.
• Perform accurate and timely data entry tasks to support departmental workflows and maintain high data integrity.
• Receive and coordinate notifications of inpatient admissions and discharges, routing information to appropriate case managers.
• Research, update, and maintain team files to ensure accurate tracking of member eligibility and case assignments.
• Collaborate with interdisciplinary teams to resolve member issues and provide seamless care coordination.
• Ensure compliance with departmental standards and regulatory requirements in all aspects of managed care operations.
• Support care management activities by routing cases requiring clinical review to appropriate staff.

Managed Care Coordinator Job Requirements

• High School Diploma or equivalent required; college degree preferred for enhanced qualifications.
• Minimum of one year of managed care experience, preferably in a healthcare setting.
• Familiarity with medical terminology, utilization management, or case management is highly desirable.
• Strong written and oral communication skills to effectively interact with members and interdisciplinary teams.
• Analytical abilities to assess member needs and recommend alternative levels of care.
• Empathy and understanding to handle confidential aspects of member care coordination.
• Ability to work independently while recognizing issues impacting departmental or organizational goals.
• Proficiency in maintaining collegial relationships and collaborating within interdisciplinary team environments.