Managed Care Coordinator - MetaSense Inc

General Statement:
Managed care coordinators facilitate communications between Schulman and Schachne Institute for Nursing and
Rehabilitation, insurance companies and patients/residents. They are responsible for ensuring that medical services are authorized and that regulatory guidelines are followed. They also manage health records and make sure that all services and requests are properly documented.

Primary Responsibilities:
-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.
-Communicates with physicians, discharge planners and others to process referrals, authorization for services,
and capture data related to utilization.
-Coordinates referrals and authorizations for services required to improve the patient/resident\'s health status.
-Manages all denials for lack of medical necessity, lack of authorization and lack of clinical information.
-Facilitates communications to and from insurance companies.
-Ensures the clinical information is delivered to the insurance carrier on a timely basis.
-Reviews daily all communications received via fax, email or mail.
-Works collaboratively with Business Office and Admission Department to ensure the updates have been
completed in the payer systems.
-Coordinates Sub-Acute Discharge meeting in collaboration with Nursing Department, Social Services
Department, Rehabilitation Services Department, and Business Office.
-Completes special managed care projects; performs independent research and prepares/gathers information for
reports and data summaries.
-Assists other departments with projects as needed in the spirit of teamwork.
-All other duties as requested.

Required Skills & Experience:
-Minimum two (2) years of experience in health management or health field.
-Positive relationship building
-Strong interpersonal and verbal communication skills.
-Organized with an ability to work independently to complete projects.
-Detail oriented with consistent follow-through.
-Excellent writing, listening and problem solving skills.
-Proficient with Microsoft Office suite applications such as Word and Excel.

Required Education:
-Bachelors Degree in Nursing.

Preferred Education:
-Masters Degree highly desired.

Required Certifications & Licensure:
-New York State Registered Nursing license