CREDENTIAL AND MANAGED CARE COORDINATOR

2 weeks ago


Norfolk VA USA, United States US Oncology, Inc. Full time
Overview

Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Credentialing Managed Care Coordinator for our office in Norfolk.

* Please take this quick survey once you've submitted your resume to complete the application process: Credential and Managed Care PI Survey

Responsibilities

* Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommends process improvements.
* Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers.
* Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
* May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payer and other contracted service providers (labs, hospitals).
* May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payers according to policy and procedure. May produce monthly managed care reports and implement new analysis tools to assist in reporting functions.
* May maintain expected reimbursement by CPT code for the top payer contracts in each market and communicate changes to system librarian.
* May develop and provide maintenance of proformas for all contracts.
* Supports Network Contracting Representative/Manager in general administrative functions.
* Trains junior and practice staff with respect to credentialing contracts, policies and procedures.
* Other duties as requested or assigned.

Qualifications

* High school diploma or equivalent required.
* Technical certification or Associates Degree a plus.
* At least five (5) years of credentialing related work experience required.
* Proficiency with computer systems and Microsoft (Office Outlook, Word, Power Point, and Excel) required.
* CPCS certification is preferred.

  • Norfolk, United States Virginia Oncology Associates Full time

    Overview: Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Credentialing Managed Care Coordinator for our office in Norfolk. ***Please take this quick survey once you've submitted your resume to...


  • Norfolk, United States US Oncology Full time

    Overview Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Credentialing Managed Care Coordinator for our office in Norfolk. Please take this quick survey once you've submitted your resume to complete...


  • Tempe, AZ 85282, USA, United States CRISIS PREPARATION AND RECOVERY, Inc. Full time

    A Care Management Coordinator will be responsible for assisting outpatient counseling providers and psychiatric nurse practitioners with care management support, maintaining compliance with their caseloads, coordination of care with primary care physicians and other health care agencies, and completing outreach to clients that are not engaged in services....


  • Brea, CA, USA, United States Randstad North America, Inc. Full time

    \t. Point of contact to facilitate the interview, credentialing, and hospital application processes for new physician and APC candidates\t. Attend Physician Recruitment meetings with Medical Director(s), Practice Development, and PS&D to disc Credentialing, Coordinator, Medical Director, Medical, Business Services, Staffing


  • Birmingham, AL 35298, USA, United States Ascension Health Full time

    **Details**+ **Department:** Medical Affairs - Credentialing+ **Schedule:** M-F 8-4:30pm+ **Hospital:** Ascension St. Vincent's East+ **Location:** Trussville, ALThe Credentialing Verification Office is located at St. Vincent's East in Trussville. You will work closely with the other site Coordinators, Administration, Medical Staff and the CMO to...


  • Redlands, CA 92373, USA, United States Loma Linda University Medical Center Full time

    Job Summary: The Coordinator-Managed Care works under the supervision of Manager Managed Care. Provides LLEAP Tapestry training to LLUHC Departments. Tracks Bed Day activity, admits, discharges, and Emergency Room services. Approves referral requests within the scope of position, according to health plan criteria and health plan benefit. Arranges for...

  • CARE COORDINATOR

    7 days ago


    Berlin, NJ 08009, USA, United States Griswold Home Care, Inc Full time

    Job Summary: Griswold Home Care of Camden County is seeking a highly motivated and compassionate individual for the role of Care Coordinator. This is a full-time administrative position in the healthcare industry located in Berlin, New Jersey. The ideal candidate will be responsible for coordinating care services for our clients and will serve as a liaison...


  • Richmond, VA, USA, United States CVS Pharmacy, Inc. Full time

    Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.-Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for mem Management, Coordinator, Special Education, Evaluation, Healthcare, Medical, Retail


  • Norfolk, United States Sentara Healthcare Full time

    **Sentara Norfolk General Hospital is hiring a Team Coordinator, Patient Care Services RN for the Emergency Department.** **This position is full-time/evening position 3p-11p (will consider other evening shifts)** **Minimum Experience Required: Level 2 Trauma (Level 1 Preferred)** Position shares the 24/7 responsibility to assist the manager for the daily...


  • Portsmouth, VA, United States Portsmouth Health and Rehab Full time

    : #ZR: MDS and Care Plan Coordinator -: Galax Health and Rehab Center Galax, VA: #IND1: Why a career with us?: When you join our team, you’ll work alongside extraordinary teammates who share our passion for helping others. In return, you’ll enjoy the following Benefits of Caring: * Daily Pay – our on-demand mobile app that allows you to access...


  • Norfolk, VA 23510, USA, United States US Oncology, Inc. Full time

    OverviewVirginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a PRN Chemo Education Nurse to join our team in Norfolk.* Please take this quick survey once you've submitted your resume to complete the...


  • Seattle, WA 98168, USA, United States Continuum Care of King Full time

    Continuum Care of King - JOB TITLE: Clinical Care CoordinatorSUPERVISOR: Regional Office ManagerWAGE: $26-29 / hour DOESCHEDULE: Monday - Friday 8 am to 5 pm with 1 hour lunchJOB DESCRIPTION SUMMARYThe Clinical Care Coordinator provides administrative support to the Clinical Care team by managing the electronic medical records system. The Clinical Care...


  • Allentown, PA 18102, USA, United States option companion care Full time

    Job SummaryWe are seeking a Patient Care Coordinator to join our team. In this role, you will work collaboratively with patients to determine their medical needs, develop the best course of action, and oversee their treatment plans, ensuring each client gets high-quality, individualized care. The ideal candidate is compassionate, patient, and knowledgeable...


  • Norfolk, United States Royal Care Inc Full time

    Job DescriptionJob DescriptionJob DescriptionHome Health Care agency with an office in Norfolk,Virginia is looking for a Contract/Full/part time Home Care / Health Care Sales/Marketing Coordinator (Marketer) in State of Virginia.Responsibilities and DutiesThe Home Care /Healthcare Sales & Marketing Coordinator will have experience in developing and implement...


  • Springfield, VT 05156, USA, United States Springfield Medical Care Systems Full time

    ApplyJob TypeFull-timeDescriptionNorth Star Health, an independent Federally Qualified Health Center comprised of multiple PCMH practices delivering team-based care in Southern VT and Southwestern New Hampshire, is seeking Clinical Care Coordinator at our Springfield Health Center. In this pivotal role, you will engage individuals seeking to prevent and...


  • Norfolk, VA, United States Sentara Medical Group Full time

    Sentara Medical Group is seeking an APP Team Coordinator to manage the daily operations and administrative responsibilities for our Cardiology subspecialties: Electrophysiology, Advanced Heart Failure, and Structural Heart. The team coordinator will work with division and specialty leadership to develop, implement, and maintain clinical and programmatic...

  • RN CARE COORDINATOR

    1 week ago


    Richmond, VA, USA, United States VCU Health Full time

    **$10,000 Sign On Bonus for offers accepted by June 30, 2024. Terms and Conditions apply**The RN Care Coordinator functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers. This position ensures that patient's progress in the acute episode of care through post discharge is quality driven...


  • Fredericksburg, VA 22403, USA, United States Tarantino Properties, Inc. Full time

    Tarantino Properties is a full-service real estate company specializing in income producing real estate. Founded in 1980, our company provides a full complement of property management, brokerage, leasing and renovation services for commercial, reside Care Coordinator, Resident, Coordinator, Director, Property Management, Staff


  • New Canton, VA 23123, USA, United States CENTRAL VIRGINIA HEALTH SERV Full time

    PURPOSE: To ensure eligible patients receive coordination of care through proper utilization of services and resources. The RN Case Manager/Care Coordinator Supervisor has an overall responsibility and accountability for the direct management and coordination of the care coordinators, including administration, staff supervision, and monitoring of program...


  • Fredericksburg, VA, United States Res-Care, Inc Full time

    Registered Nurse Case Manager - Hospice AT Home Care & Hospice Our Hospice Registered Nurse (RN) Case Managers are the heart of our organization! In this role, you will support your patients by providing direct care and coordinating with the interdisciplinary team to ensure that both patients and their families have an optimal care experience. Medical and...