Coordinator, Managed Care

Company Name:
Cherokee Nation
Responsibilities include establishing, implementing, maintaining, and evaluating the managed care program for the assigned area including making referrals, setting up appointments with vendors and processing required paperwork.
Routine duties shall include providing health care services to individuals eligible for services in accordance with the self-governance compact and funding agreement between the Cherokee Nation and United States executive under the authority of the Indian Self-Determination and Education Assistance Act. Establishes, implements, maintains and evaluates the Managed Care program for the assigned area. Makes recommendations and states concerns to the rural health center contract health services committee. Develops and administers the purchases (contract) patient services for the facility by working closely with clinicians and processing referrals. Schedules appointments for the patient with the vendor and gathers information that will be needed by the patient and vendor. Notifies appropriate personnel of vendor cost above the normal fee range. Maintains filing as required. Verifies patient eligibility and make notifications od denials. Coordinates and utilizes third party resources for patient care services provided outside the rural health center. Manages the automated RPMS managed care system and related databases. Processes vendor invoices by submitting them to accounting as required. Maintains a vendor list, which identifies private vendors and services provided. Makes reports as required. Monitors expenses closely and keeps appropriate personnel up to date. Other duties may be assigned.
No supervisory responsibilities are required.
High school education; or general education degree (GED).
An additional five years experience with various health care delivery systems including inpatient, outpatient, emergency care, specialty care, diagnostic categories and current treatment modalities and/or patient care case management is required.
Must have a valid driver''s license with a driving history verified through a motor vehicle report that meets requirements for Cherokee nation underwriting rating. Must be certified in CPR. Must have completed some health-related courses or studied medical terminology.
Must be familiar with ICD-9 CM and CPT-5 coding, various insurance knowledge such as group individual and private plans, medical records, hospital policies, physician office policies and Medicare/Medicaid.
Date: 2014-06-04
Country: US
State: OK
City: Tahlequah
Postal Code: 74464
Job Type: Regular Full-Time

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