Managed Care Coordinator

Managed Care Coordinator Overview

The Managed Care Coordinator assists and supports the LPN/RN MDS Coordinator with case management responsibilities. The candidate is the primary liaison between the SNF and the HMO Managed Care Insurance Companies. This includes all types of communication (eFax, email, scan documents, phone calls) with case managers to provide concurrent updates as requested by Insurance Companies, handles Third Party appeals, peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the discretion of the MDS Coordinator.

Managed Care Coordinator Essential Job Fuctions

Able to successfully interact with HMO Case Managers in a professional manner.
• Duties include scanning the documents from the EMR after the MDS Coordinator reviews.
• Participate in interdisciplinary team meetings as needed by the MDS Coordinator.
• Understands the organization's quality management program and the care coordinator's role within that program, with compliance of all policies and procedures.
• Maintains privacy, as per policies and procedures within a secure environment of documentation and communication.
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
• Utilizes electronic timekeeping system as directed.
• Arrives to work on time, regularly, and works as scheduled.
• Recognizes and follows the dress code of the facility including wearing name tag at all times.
• Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
• Supports and abides by Elderwood's Mission, Vision, and Values.
• Abides by Elderwood's businesses code of conduct, compliance and HIPAA policies.
• Performs other duties as assigned by supervisor, management staff or Administrator.

Managed Care Coordinator Educational Requirements and Qualifications

• Minimum of High School Diploma
• 1 - 2 years of experience within the HMO Managed Care Insurance Companies
• Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review.

Managed Care Coordinator Skills and Competencies

• Demonstrated proficiency with Microsoft Office
• Bilingual English/Spanish speaking preferred
• This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.