Overview Care Coordinator Central DD-Little Rock (Pulaski Co.).
Position Summary The Managed Care Coordinator plays a crucial role in facilitating and coordinating the delivery of managed care services within an organization. This position is responsible for managing and overseeing the administrative processes associated with managed care plans, ensuring compliance with relevant regulations, and ensuring effective communication between healthcare providers, insurance companies, and patients.
Key Responsibilities Coordinate Managed Care Services: Oversee and facilitate the coordination of managed care services, including verifying eligibility, managing referrals, and obtaining authorizations for medical procedures, treatments, and services. Deliver personalized health education and coaching to members based on identified concerns outlined in treatment and service plan. requested services, ensuring compliance with established guidelines and policies.
Insurance Verification: Verify insurance coverage and benefits for patients, ensuring accurate and up-to-date information is obtained and documented.
Utilization and Collaboration: Conduct utilization reviews to evaluate medical necessity and appropriateness of services; collaborate with insurance companies and healthcare providers to ensure availability and quality of services; facilitate coordination with diverse healthcare providers for diagnostics, ambulatory care, and hospital services.
Member Advocacy: Serve as a point of contact for members, addressing questions, concerns, and complaints related to managed care services, and advocating for their needs within the organization; encourage initiatives aimed at improving the health of patients and their communities, including outreach efforts, quality improvement initiatives, and patient panel management; coordinate community-based management of medication therapy.
Compliance and Documentation: Ensure compliance with applicable laws, regulations, and contractual obligations related to managed care services. Maintain accurate and complete documentation of all interactions, authorizations, and communications; ensure compliance with the PCSP and assist with resources needed or barriers to accessing treatment.
Continuous Improvement: Identify opportunities for process improvement and efficiency enhancement in managed care operations. Propose and implement strategies to optimize service delivery and enhance patient satisfaction; collaborate with both external and internal stakeholders to ensure high service efficiency.
Education And Experience High School diploma and one (1) year experience in the mental health field.
Bachelor's degree in a relevant field such as healthcare, social work, psychology or social services and other healthcare related field preferred.
Knowledge of managed care principles, processes, and regulations.
Familiarity with health insurance terminology, coverage, and benefit structures.
Strong organizational skills with the ability to manage multiple tasks simultaneously.
Excellent communication and interpersonal skills to effectively collaborate with internal and external stakeholders.
Detail-oriented and ability to maintain accurate records and documentation.
Proficiency in using computer systems and software applications relevant to managed care operations.
License/Certification A valid driver’s license and up-to-date automobile insurance as required by state law.
Physical Requirements Must be able to drive and perform quarterly visits to members.
Prolonged periods of sitting at a desk and working on a computer.
The ability to occasionally lift objects weighing up to 15 pounds is required.
Note This job description is not intended to be exhaustive. It outlines the fundamental duties and minimum qualifications for this position. The individual(s) holding this position may be assigned additional job-related responsibilities beyond those specified. Management reserves the right to assign or reassign responsibilities. Some functions are essential, including attendance, teamwork, working a complete shift, and performing under stressful conditions. Reasonable accommodations will be provided under the Americans with Disabilities Act (ADA) where feasible.