Managed Care Coordinator Job Description [Updated for 2025]

In today’s healthcare landscape, the importance of Managed Care Coordinators is paramount.

As healthcare systems evolve, the demand for proficient individuals who can efficiently navigate, enhance, and secure our managed care processes grows exponentially.

But what exactly is expected from a Managed Care Coordinator?

Whether you are:

• An aspirant trying to understand the core of this role,
• A hiring manager defining the perfect candidate,
• Or simply curious about the dynamics of managed care coordination,

You’ve come to the right place.

Today, we present a fully customizable Managed Care Coordinator job description template, designed for easy posting on job boards or career sites.

Let’s dive right in.

Managed Care Coordinator Duties and Responsibilities

Managed Care Coordinators work in the healthcare field, and their main responsibility is to ensure that patients receive the appropriate healthcare they need within their insurance coverage.

The duties and responsibilities of a Managed Care Coordinator include:

• Coordinating and managing patient care to ensure the best possible outcome
• Assessing patient needs and developing care plans
• Communicating with patients and their families about their healthcare plans and options
• Working closely with healthcare providers to establish and implement patient treatment plans
• Negotiating contracts with healthcare providers and insurance companies
• Ensuring healthcare services are provided in the most cost-effective manner without compromising the quality of care
• Maintaining patient records and ensuring patient confidentiality
• Keeping up to date with changes in healthcare laws, regulations, and policies
• Providing education to patients and their families about insurance coverage and healthcare options
• Coordinating and facilitating communication between different healthcare providers, including doctors, nurses, and specialists

 

Managed Care Coordinator Job Description Template

Job Brief

We are seeking a detail-oriented and diligent Managed Care Coordinator to manage and improve the efficiency of our healthcare services.

The Managed Care Coordinator’s responsibilities include developing and maintaining relationships with healthcare providers, negotiating contracts, ensuring that the provided healthcare services are up to standard, and overseeing patient care.

The ideal candidate should have a deep understanding of healthcare regulations and medical terminologies, with exceptional interpersonal and negotiation skills.

Ultimately, the role of the Managed Care Coordinator is to ensure the smooth operation and coordination of healthcare services that comply with company policies and healthcare regulations.

 

Responsibilities

• Coordinate and manage healthcare services for patients
• Negotiate contracts and rates with healthcare providers
• Develop and maintain relationships with healthcare providers
• Ensure that healthcare services provided are up to standard
• Oversee patient care and address any issues or complaints
• Comply with healthcare regulations and company policies
• Prepare reports on the efficiency and effectiveness of healthcare services
• Implement strategies for improving the quality of healthcare services

 

Qualifications

• Proven work experience as a Managed Care Coordinator or in a similar role in healthcare management
• Knowledge of healthcare regulations and medical terminologies
• Strong negotiation and relationship management skills
• Excellent interpersonal and communication skills
• Ability to manage and coordinate healthcare services efficiently
• Proficiency in healthcare management software
• A degree in healthcare administration, management, or a related field

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Retirement plan
• Paid time off
• Professional development opportunities

 

Additional Information

• Job Title: Managed Care Coordinator
• Work Environment: Office setting in a healthcare facility. Some travel may be required for meetings with healthcare providers.
• Reporting Structure: Reports to the Managed Care Director or Healthcare Administrator.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $60,000 minimum to $80,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Managed Care Coordinator Do?

Managed Care Coordinators are healthcare professionals who typically work for hospitals, clinics, or healthcare organizations.

Their primary role is to coordinate and manage the care of patients within a managed care system.

They act as a liaison between patients, healthcare providers, and insurance companies, ensuring that the necessary services are provided efficiently and in a cost-effective manner.

Managed Care Coordinators review and analyze patient care plans, facilitate authorization and referrals, and monitor the quality of care provided.

They collaborate with healthcare providers, patients, and families to develop individualized care plans that meet patients’ needs and goals.

These professionals also play a crucial role in patient education.

They inform patients about their health conditions, treatment options, and insurance benefits, helping them make informed decisions about their healthcare.

Additionally, Managed Care Coordinators are responsible for maintaining up-to-date knowledge of regulations, guidelines, and policies related to managed care.

They ensure that the healthcare organization’s practices are compliant with these regulations.

Lastly, they may also be involved in data analysis, tracking patient outcomes, and identifying areas for improvement in the managed care system.

 

Managed Care Coordinator Qualifications and Skills

A proficient Managed Care Coordinator should possess an array of skills and qualifications that correspond with the job description, such as:

• Excellent knowledge of healthcare operations and managed care principles to ensure effective coordination of care services.
• Strong organizational skills to manage multiple tasks simultaneously such as scheduling, monitoring patient care, and tracking progress.
• Effective communication skills, both verbal and written, to liaise with health care providers, patients, and families, ensuring all parties are aware of care plans and any changes.
• Analytical skills to evaluate patient needs, develop care plans, and assess the efficiency and success of the care provided.
• Problem-solving abilities to address any issues that arise in the care coordination process, ensuring patients receive timely and appropriate care.
• Interpersonal skills to establish and maintain positive relationships with patients, families, healthcare providers, and insurance companies.
• Familiarity with medical terminology, insurance procedures, and billing processes to ensure smooth operations and accurate record keeping.
• Ability to maintain patient confidentiality and adhere to ethical guidelines and standards of the profession.

 

Managed Care Coordinator Experience Requirements

Entry-level Managed Care Coordinator candidates typically have 1 to 2 years of experience in the healthcare field, often gained through internships or part-time roles in hospital administration, healthcare management, or nursing.

Those who have completed relevant healthcare programs or degrees, such as a Bachelor’s in Healthcare Administration, may have gathered practical experience through their course work.

Candidates with 3 to 5 years of experience usually have developed their skills in roles such as Care Coordinator, Health Services Manager, or Case Manager, where they learned to negotiate with healthcare providers, oversee patient care plans, and ensure compliance with healthcare regulations and laws.

Those with over 5 years of experience, and especially those with a Master’s degree in Healthcare Administration or a related field, may have substantial leadership experience.

They may be ready for senior-level Managed Care Coordinator roles, or even for managerial positions in the managed care department.

Finally, a current and valid Registered Nurse (RN) license, or equivalent, may be required for some Managed Care Coordinator roles, as they may involve direct patient care coordination.

Thus, previous nursing experience can be a significant advantage for candidates.

 

Managed Care Coordinator Education and Training Requirements

Managed Care Coordinators typically require a bachelor’s degree in nursing, health administration or a related field.

The curriculum for these programs typically includes courses on health care policy, ethics in health care, health care marketing, health care informatics, and health care law.

In addition to their degree, many employers prefer candidates with previous experience in managed care or health care administration.

This experience can be obtained through internships, volunteering, or employment in a health care setting.

Some positions may require Managed Care Coordinators to be a licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Certain roles might also demand Managed Care Coordinators to hold a master’s degree in health administration, public health, or a related field.

This level of education often signifies a candidate’s ability to handle higher-level responsibilities and indicates their commitment to the profession.

Additionally, some Managed Care Coordinators may pursue certification through organizations like the American Association of Managed Care Nurses or the Commission for Case Manager Certification.

These certifications can help candidates demonstrate their expertise in the field and may be preferred or required by some employers.

Continuing education is often necessary in this role as changes occur in healthcare regulations and practices.

 

Managed Care Coordinator Salary Expectations

A Managed Care Coordinator can expect to earn an average salary of $60,000 (USD) per year.

The actual earnings may vary depending on factors such as experience, qualifications, the size and type of the employing organization, and the geographical location.

 

Managed Care Coordinator Job Description FAQs

What skills does a Managed Care Coordinator need?

Managed Care Coordinators should have strong communication and interpersonal skills for interaction with healthcare providers, patients, and insurance companies.

They need to be highly organized, detail-oriented, and have the ability to multitask.

Knowledge of healthcare laws and insurance policies is also beneficial.

They should also have good problem-solving and negotiation skills.

 

Do Managed Care Coordinators need a degree?

Yes, a Managed Care Coordinator typically needs to have a bachelor’s degree in healthcare administration, nursing, or a related field.

Some employers may also prefer candidates who have a master’s degree.

Experience in a healthcare setting is also often required.

 

What should you look for in a Managed Care Coordinator resume?

A Managed Care Coordinator’s resume should include evidence of a relevant educational background and experience in healthcare coordination, especially in managed care settings.

The resume should highlight their skills in organization, communication, and knowledge of health insurance policies and regulations.

Certifications in managed care or healthcare management can also be a plus.

 

What qualities make a good Managed Care Coordinator?

A good Managed Care Coordinator is patient-centric and committed to ensuring patients receive the best care within their insurance limitations.

They should be efficient, able to manage their time well and prioritize tasks.

They should also be able to work well under pressure, and be able to negotiate and resolve conflicts effectively.

 

Is it difficult to hire Managed Care Coordinators?

Finding the right candidate for a Managed Care Coordinator position can be challenging, as the role requires a unique blend of healthcare knowledge and administrative skills.

In addition, these professionals need to have a deep understanding of complex insurance guidelines and a dedication to patient advocacy, making the hiring process somewhat complex.

 

Conclusion

And there we have it.

Today, we’ve unraveled the complexity behind what it truly means to be a Managed Care Coordinator.

And you know what?

It’s not just about coordinating healthcare services.

It’s about shaping the future of healthcare, one plan at a time.

With our tailored Managed Care Coordinator job description template and real-world examples, you’re ready to make your career move.

But why limit yourself?

Explore more with our job description generator. It’s your next step to creating detailed job listings or polishing your resume to perfection.

Remember:

Every care plan is a step towards the bigger picture.

Let’s shape the future of healthcare. Together.

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