Care Coordination Manager

2 weeks ago

New York, United States PROMESA R.H.C.F. Full time
Job Overview

POSITION SUMMARY:

The Care Coordination Manager plays a crucial role in overseeing daily operations related to effective communication with external case managers from referring healthcare facilities and managed care organizations (MCOs). This position is pivotal for data gathering, analysis, and the certification/recertification processes from third-party payers, spanning from pre-admission to discharge. The manager will also conduct ongoing medical necessity evaluations and provide interdisciplinary team support in alignment with MCO requirements.

KEY RESPONSIBILITIES:

  • Secure necessary pre-authorization and certification for specified services from MCOs, while effectively communicating any changes in benefit status or reimbursement to relevant departments.
  • Perform continuous medical necessity assessments, which may include pre-service, concurrent, and retrospective reviews, by analyzing clinical data and submitting necessary documentation to update patient status with MCOs.
  • Act as a liaison between the residential program and MCOs to streamline the reimbursement process.
  • Manage appeals for MCO denials and non-covered services by collaborating with directors to determine next steps.
  • Conduct thorough medical record reviews for all managed care patients within the initial 24 to 72 hours of admission, followed by weekly evaluations to ensure optimal clinical and financial outcomes, including:
  1. Engaging with managed care residents to assist in selecting appropriate provider resources and identifying quality, cost-effective services throughout their care continuum.
  2. Serving as a resource for the interdisciplinary team regarding MCO admission, continued stay, and discharge planning requirements.
  3. Facilitating early identification of covered care to ensure claims are approved when guidelines are satisfied.
Collaborate with clinical staff to assess discharge needs and coordinate with Social Services for the development and execution of discharge or transfer plans.Ensure post-discharge follow-up care is arranged with selected patients and community providers.Exhibit strong leadership capabilities to manage multiple functions and a diverse range of tasks requiring independent judgment and initiative.Engage with executives, directors, key residential team members, physicians, third-party payers, state and federal agencies, auditors, and vendors.Maintain a high level of proficiency in MS Word and MS Excel, essential for conducting data analysis.Ensure all information is handled with strict confidentiality and in compliance with HIPAA regulations.Stay informed about state and federal regulations relevant to resident assessment requirements.Perform additional tasks and special projects as assigned.

QUALIFICATIONS:

  • A minimum of 2 years of experience in case management or utilization review.
  • Associate degree required; bachelor's degree preferred.
  • Strong analytical and problem-solving skills to interpret and analyze statistical data.
  • Exceptional oral, written, organizational, and interpersonal communication abilities.
  • Proven ability to communicate effectively with senior leadership and other clinical/non-clinical personnel.
  • Demonstrated capacity to collaborate effectively with peers and senior leadership on projects and presentations.

  • Care Coordinator

    4 weeks ago

    New York, United States Village Care Full time

    Job DescriptionJob DescriptionCare CoordinatorVillageCareMAX112 Charles Street, New York, NY 10014VillageCareMAX is looking for a motivated individual for this Full-Time role to provide assistance to care managers and members in coordinating services and requests. The Care Coordinator will work to authorize services based on plan of care and ensure that...

  • Care Coordinator

    4 weeks ago

    New York, United States Village Care Full time

    Care CoordinatorVillageCareMAX112 Charles Street, New York, NY 10014VillageCareMAX is looking for a motivated individual for this Full-Time role to provide assistance to care managers and members in coordinating services and requests. The Care Coordinator will work to authorize services based on plan of care and ensure that services are initiated and...

  • Care Coordinator

    2 days ago

    New York, New York, United States Independence Care System Full time

    Job SummaryWe are seeking a highly skilled Care Coordinator to join our team at Independence Care System. As a Care Coordinator, you will play a critical role in coordinating the care of our members, ensuring they receive the necessary health and social supports to maintain their health, mobility, and independence in the community.Key ResponsibilitiesMember...

  • Administrative Coordinator

    1 week ago

    New York, New York, United States Arc Fund Manager LLC Full time

    Job OverviewAdministrative CoordinatorArc Fund Manager LLC is in search of an Administrative Coordinator to enhance their operational efficiency. This position encompasses a range of clerical tasks and specialized initiatives within the venture capital and property management sectors.Front Desk Responsibilities: Welcome guests, handle incoming calls, oversee...

  • Care Coordinator

    3 months ago

    New York, United States Village Care Full time

    Job DescriptionJob DescriptionCare CoordinatorVillageCareMAX112 Charles Street, New York, NY 10014VillageCareMAX is looking for a motivated individual for this Full-Time role to provide assistance to care managers and members in coordinating services and requests. The Care Coordinator will work to authorize services based on plan of care and ensure that...

  • Patient Care Coordinator

    2 weeks ago

    New York, New York, United States Village Care Full time

    Care CoordinatorCompany: VillageCareMAXVillageCareMAX is seeking a dedicated professional for a Full-Time position to assist care managers and members in the organization of services and requests. The Care Coordinator will be responsible for authorizing services based on the established care plan and ensuring that services are effectively initiated and...

  • Registered Nurse

    2 weeks ago

    New York, New York, United States Village Care Full time

    Job OverviewPosition: Registered Nurse - Care CoordinatorFocus: Medicare - DSNP/MAP*Remote Work Opportunity*Join Village Care as a Full-Time Registered Nurse - Care Coordinator. This role offers the flexibility of remote work while providing essential care and support to our members in the greater NYC area. As a vital member of our organization, you will...

  • Patient Care Coordinator

    1 week ago

    New York, New York, United States Village Care Full time

    Position: Care CoordinatorCompany: VillageCareMAXVillageCareMAX is seeking a dedicated professional for a Full-Time position focused on assisting care managers and members in the orchestration of services and requests. The Care Coordinator will be responsible for authorizing services in alignment with the care plan and ensuring that these services are...

  • Care Management Coordinator

    1 week ago

    New York, United States HR Employer Solutions Group Full time

    Job DescriptionJob DescriptionCare Management CoordinatorJob DescriptionWe are seeking a highly organized and detail-oriented Care Management Coordinator to join our team. As a Care Management Coordinator, you will be responsible for coordinating and facilitating care management services for our clients. You will play a critical role in ensuring the smooth...

  • Home Care Staffing Coordinator

    2 days ago

    New York, United States True Care Full time

    Job SummaryWe are seeking a highly skilled and compassionate Home Care Staffing Coordinator to join our team at True Care. As a key member of our coordination team, you will play a vital role in ensuring the seamless delivery of high-quality home healthcare services to our clients.Key ResponsibilitiesStrategic Caregiver Placement: Coordinate the placement of...

  • Managed Care Coordinator

    1 week ago

    New York, New York, United States Metropolitan Jewish Health System Full time

    About Metropolitan Jewish Health SystemMJHS is a leading not-for-profit health system in the Greater New York area, providing a comprehensive range of health services to adults and children. Our mission is to deliver high-quality care and support to our patients, residents, and health plan members.Job SummaryWe are seeking a highly skilled Managed Care...

  • Managed Care Coordinator

    4 months ago

    New York, United States Metropolitan Jewish Health System Full time

    The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life...

  • Managed Care Coordinator

    1 week ago

    New York, New York, United States Metropolitan Jewish Health System Full time

    About Metropolitan Jewish Health SystemMJHS is a leading not-for-profit health system in the Greater New York area, providing a comprehensive range of health services to adults and children. Our mission is to deliver high-quality care and support to our patients and their families.Job SummaryWe are seeking a highly skilled Managed Care Coordinator to join...

  • Care Coordinator

    3 days ago

    New York, New York, United States Village Care Full time

    About the RoleWe are seeking a highly motivated and organized Care Coordinator to join our team at VillageCare. As a Care Coordinator, you will play a critical role in coordinating services and requests for our members, working closely with care management teams, providers, and external partners to ensure seamless delivery of care.Key ResponsibilitiesMember...

  • Managed Care Coordinator

    3 weeks ago

    New York, United States MetaSense Inc Full time

    Job DescriptionJob DescriptionGeneral Statement:Managed care coordinators facilitate communications between Schulman and Schachne Institute for Nursing andRehabilitation, 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...

  • TGNB Case Manager Coordinator

    1 month ago

    New York, United States Amida Care Full time

    Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This...

  • Managed Care Coordinator

    2 months ago

    New York, United States Metropolitan Jewish Health System Full time

    Overview: The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and...

  • Executive Administrative Coordinator

    2 weeks ago

    New York, New York, United States Multi-Billion Dollar Asset Manager Full time

    A prominent Multi-Billion Dollar Asset Manager is in search of a skilled Administrative Coordinator to deliver comprehensive support across various functions. This position entails a wide range of traditional corporate administrative responsibilities, along with opportunities to engage in project-oriented tasks. The organization prides itself on its positive...

  • Care Management Coordinator

    4 months ago

    New York, United States Metropolitan Jewish Health System Full time

    The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life...

  • Executive Administrative Coordinator

    1 week ago

    New York, New York, United States Multi-Billion Dollar Asset Manager Full time

    A prominent firm in the asset management sector is looking for a skilled Administrative Coordinator to deliver comprehensive support on a flexible basis. This position entails a variety of essential corporate administrative duties while also having the opportunity to engage in project-related tasks. The organization fosters a positive work environment and...