What does a managed care coordinator do?
Managed care coordinators handle various operational and medical issues for a health care facility or insurance company. Their duties include ensuring effective communication between medical facilities, patients, and insurance companies, handling medical files and documentation requests, and communicating with physicians and other health care professionals to process referrals and authorize services. In addition, they are responsible for maintaining managed care contracts and preparing reports, and working closely with care management members to assess health needs and facilitate services.
Managed care coordinator responsibilities
Here are examples of responsibilities from real managed care coordinator resumes:
- Manage ICD-9 coding and DRG validation for high volume of claims.
- Ensure all clinical operations comply with Medicare and Medicaid guidelines and other manage care policies.
- Manage caseload by providing care coordination to individuals with a primary intellectual/developmental disability diagnosis all of whom receive community-base waiver services.
- Adhere to all state, accreditation standards and regulatory guidelines which include HIPAA guidelines and NCQA accreditation.
- Enter and approve authorizations for patients being discharge from hospitals to a sub- acute rehabilitation facility or a skil nursing facility.
- Review ICD-9 and HCPCS codes to insure proper coding used on claims.
- Verify CPT codes requiring authorization and network versus non-network providers.
- Conduct insurance appeals for treatment coverage via written and telephonic forms of communications.
- Prepared/Correlate appeals for retroactive denials by third party players for appropriate committee action.
- Design, develop, and coordinate service utilization in rehabilitation department of hospital system.
- Document confidential patient information, ensuring strict confidentiality, in compliance with HIPAA regulations.
- Conduct telephone outreach efforts relate to Medicaid population to enroll appropriate members in specialize disease programs.
- Work closely with different medical and insurance facilities by facilitating accurate patients' information to account receivables department.
- Complete behavioral health assessment to determine level of care for patients experiencing psychiatric emergency or detoxification from substances.
- Design customized PowerPoint marketing material for both prospective and existing client presentations addressing investment philosophy, investment strategy and portfolio analysis.
Managed care coordinator skills and personality traits
We calculated that 17% of Managed Care Coordinators are proficient in Patients, Social Work, and Home Health. They’re also known for soft skills such as Analytical skills, Leadership skills, and Technical skills.
We break down the percentage of Managed Care Coordinators that have these skills listed on their resume here:
- Patients, 17%
Organized the multidisciplinary discharge process for an assigned patient population Provided education to patients with regards to specific disease processes
- Social Work, 15%
Collaborated extensively with social workers, physicians and other specialists to facilitate care processes and ensure comprehensive accuracy among all documentation.
- Home Health, 10%
Facilitated and coordinated authorizations for Home Health Care visits.
- Customer Service, 8%
Recognized by management for excellent performance regarding TAT, superior customer service, and accountability with providers.
- Discharge Planning, 5%
Coordinated member's admission and rehabilitation and discharge planning procedures and transportation and interpretation services.
- Patient Care, 5%
Promote quality, cost effective patient care by providing the interdisciplinary team all information necessary to positively influence optimal patient outcomes.
"patients," "social work," and "home health" are among the most common skills that managed care coordinators use at work. You can find even more managed care coordinator responsibilities below, including:
Analytical skills. One of the key soft skills for a managed care coordinator to have is analytical skills. You can see how this relates to what managed care coordinators do because "medical and health services managers review and evaluate healthcare metrics for ways to improve efficiency and meet goals." Additionally, a managed care coordinator resume shows how managed care coordinators use analytical skills: "maintained group purchasing orders by reconciling client invoice data with corporate fee schedules. "
Leadership skills. Many managed care coordinator duties rely on leadership skills. "medical and health services managers hire, train, and direct staff," so a managed care coordinator will need this skill often in their role. This resume example is just one of many ways managed care coordinator responsibilities rely on leadership skills: "team leadership including engagement, performance management and evaluations. "
Technical skills. managed care coordinators are also known for technical skills, which are critical to their duties. You can see how this skill relates to managed care coordinator responsibilities, because "medical and health services managers must stay up to date with advances in healthcare technology, such as the coding and electronic health record (ehr) systems their facility adopts." A managed care coordinator resume example shows how technical skills is used in the workplace: "reduced medicaid clinical and technical denials either through avoidance or appeal of $1.1 million annually. "
Detail oriented. A commonly-found skill in managed care coordinator job descriptions, "detail oriented" is essential to what managed care coordinators do. Managed care coordinator responsibilities rely on this skill because "medical and health services managers must pay attention to detail." You can also see how managed care coordinator duties rely on detail oriented in this resume example: "oriented new social work and professional registered nurse employees. "
Communication skills. Another skill commonly found on managed care coordinator job descriptions is "communication skills." It can come up quite often in managed care coordinator duties, since "medical and health services managers must convey information to their staff, other healthcare workers, and, sometimes, patients and insurance agents." Here's an example from a resume of how this skill fits into day-to-day managed care coordinator responsibilities: "ensured smooth communication between medical facility, insurance companies and patients. "
The three companies that hire the most managed care coordinators are:
- Northwell Health22 managed care coordinators jobs
- Centene21 managed care coordinators jobs
- UnitedHealth Group17 managed care coordinators jobs
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Compare different managed care coordinators
Managed care coordinator vs. Assistant director of nursing
An assistant director of nursing is responsible for administering quality care services for patients, supervising nursing activities, and ensuring the patients' comfort under the supervision of the director of nursing. Assistant directors of nursing assist with nursing staff training, distributing shift schedules, developing comprehensive nursing care plans, handling expense reports, identifying areas of improvement with the staff performance, and securing patients' medical charts for reference. An assistant director of nursing must have excellent communication and organizational skills, especially in handling patients' medical needs.
While similarities exist, there are also some differences between managed care coordinators and assistant director of nursing. For instance, managed care coordinator responsibilities require skills such as "social work," "medical terminology," "community resources," and "mental health." Whereas a assistant director of nursing is skilled in "term care," "cpr," "quality care," and "resident care." This is part of what separates the two careers.
Assistant directors of nursing tend to make the most money working in the manufacturing industry, where they earn an average salary of $85,610. In contrast, managed care coordinators make the biggest average salary, $42,132, in the health care industry.On average, assistant directors of nursing reach similar levels of education than managed care coordinators. Assistant directors of nursing are 2.7% less likely to earn a Master's Degree and 0.1% more likely to graduate with a Doctoral Degree.Managed care coordinator vs. Patient care manager
Patient care managers are executives who are in charge of supervising a clinical team. The managers take responsibility for directing patient care within an organization. Also called health care managers, they protect every patient's safety and health in a clinical setting. They interact with the healthcare team members to maintain open communication. It is also part of their duties to supervise the daily operations in the clinical care units. Managing clinical budgets and maintaining quality health services are also their responsibilities.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that managed care coordinator responsibilities requires skills like "patient care," "medical terminology," "data entry," and "cpt." But a patient care manager might use other skills in their typical duties, such as, "quality care," "substance abuse," "resident care," and "medication administration."
Patient care managers may earn a higher salary than managed care coordinators, but patient care managers earn the most pay in the health care industry with an average salary of $54,278. On the other hand, managed care coordinators receive higher pay in the health care industry, where they earn an average salary of $42,132.Average education levels between the two professions vary. Patient care managers tend to reach similar levels of education than managed care coordinators. In fact, they're 4.6% more likely to graduate with a Master's Degree and 0.1% more likely to earn a Doctoral Degree.Managed care coordinator vs. Pharmacist manager
A pharmacist manager is responsible for monitoring the daily operations of a pharmacy, ensuring that all pharmacy personnel provides the right medication to the customers based on the prescription. Pharmacist managers assist in advising the customers for the instructions of their medications, including its dosage and instructions of intake. They manage the inventory and keep safe and clean storage for the products at all times. A pharmacist manager must have a comprehensive knowledge of the medical industry, as well as excellent communication skills, especially in responding to the customers' concerns and inquiries.
The required skills of the two careers differ considerably. For example, managed care coordinators are more likely to have skills like "social work," "home health," "discharge planning," and "medical terminology." But a pharmacist manager is more likely to have skills like "compassion," "inventory management," "federal laws," and "allergies."
Pharmacist managers earn the best pay in the health care industry, where they command an average salary of $100,580. Managed care coordinators earn the highest pay from the health care industry, with an average salary of $42,132.When it comes to education, pharmacist managers tend to earn lower degree levels compared to managed care coordinators. In fact, they're 5.3% less likely to earn a Master's Degree, and 30.2% less likely to graduate with a Doctoral Degree.Managed care coordinator vs. Clinical director
A clinical director is a managing professional who manages the work of healthcare providers to ensure quality patient care is achieved. Clinical directors are responsible for organizational tasks such as adjusting staff schedules, explaining insurance benefits to the patients, and managing financial reports. They can work either in small clinics with a smaller workforce or larger hospitals with multiple departments. Clinical directors may also assist in the hiring process of healthcare providers and should establish a positive work environment.
Even though a few skill sets overlap between managed care coordinators and clinical directors, there are some differences that are important to note. For one, a managed care coordinator might have more use for skills like "medical terminology," "data entry," "good judgment," and "cpt." Meanwhile, some responsibilities of clinical directors require skills like "clinical services," "quality improvement," "autism," and "group therapy. "
Clinical directors enjoy the best pay in the health care industry, with an average salary of $79,166. For comparison, managed care coordinators earn the highest salary in the health care industry.In general, clinical directors hold higher degree levels compared to managed care coordinators. Clinical directors are 21.8% more likely to earn their Master's Degree and 9.5% more likely to graduate with a Doctoral Degree.Types of managed care coordinator
Updated January 8, 2025
