Managed care coordinators work in the health care industry, including for hospitals, medical clinics, and insurance companies, to handle a variety of medical and operational issues and ensure effective communication between insurance companies, medical facilities (doctors’ offices, hospitals, clinics), and patients. They also handle medical files and manage documentation requests from authorized parties.
A bachelor’s degree in business administration or a related field and relevant prior experience are generally required for this position, and familiarity with case management is highly beneficial. Strong multitasking and organizational skills are important in this position, and computer skills and knowledge of Adobe Acrobat, Microsoft Office programs, and database software and applications are also helpful. Some employers require managed care coordinators to travel to clients’ sites, so a valid driver's license and clean driving record may be required, and they must also protect and maintain patients’ privacy and confidentiality. They must be able to attend required training classes, and the ability to speak a second language such as Spanish is beneficial but not necessarily required. Some may also train, coach, or mentor other staff members within the facility.
Managed Care Coordinator Tasks
Coordinate utilization review of managed care contracts.
Prepare and maintain resource data for utilization activities.
Maintain knowledge of insurance requirements in managed care plans.
Confer with physician during referral process.
Act as liaison between primary care, physicians, and alternative care facility.