Managed Care Coordinator

St. Catherine Of Siena Smithtown , NY 11787

Posted 3 months ago

Job Details

Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.

Duties and Responsibilities


  • Responsible for maintaining and updating managed care contract rate grids

  • Assists in the maintenance of Joint Operating Committee action plans and follow ups.

  • Works with relevant parties to ensure deliverable from all parties are achieved in accordance with strategic timelines.

  • Maintains CHSLI master list of service locations (facility, professional and continuing care)

  • Assists in the resolution of referral, authorization and claims payment issues

  • Supports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements. Informs departments of contract terms as necessary

  • Responsible for the completion of facility credentialing for managed care payers. Accurately maintains all facility credentialing files

  • Assists Directors in payer research for new programs/services

  • Assists in the maintenance contractual term matrix and contact grids

  • Assists in the coordination of payer in-services

  • Disseminates quarterly payer policy updates

  • Maintains and updates contact and plan participation grids

  • Maintains Payer Contracts

  • Tracks single case agreement through execution process

  • Coordinates Center of Excellence application correspondence.

  • Educates and assists CHSLI employees in meeting internal and MCO operational requirements. Informs departments of contract terms for all entities


  • Works with Revenue Cycle team to identify and resolve issues related to timely payment of managed care claims.

  • Assists SVP and VP on projects as assigned

Position Requirements and Qualifications

EDUCATION: Bachelor's degree required.


  • Proficient in designing, building reports and analyses in various Microsoft based data analysis tools.

  • Proven experience working with large and complex SQL databases preferred.

  • Ability to analyze and accurately summarize complex claims data and effectively communicate conclusions

  • Proficient in project management

  • Detail oriented and strong organization skills


Previous experience with analysis preferably in a healthcare or managed care setting.

Experience with hospital billing and or decision support systems a plus.

Strong knowledge of the managed care environment including provider, payer, and employer.

At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
AVP Patient Care

St. Catherine Of Siena

Posted 2 days ago

VIEW JOBS 2/20/2020 12:00:00 AM 2020-05-20T00:00 Job Details Assistant Vice President for Patient Care Services The AVP for patient care services is responsible to assist the chief nursing officer to plan, implement, and evaluate the objectives of patient care services to assure the delivery of quality compassionate cost-effective care to patients and families. The AVP of patient care services is part of a dynamic and dedicated team of healthcare professionals who continually strive to exceed patient, family, physician and staff expectations. * Organizes, directs and monitors the delivery of patient care services related to the care of the adult, older adult and pediatric patient. * Provides effective, efficient, coordinated leader ship of patient care, assuring an exemplary patient experience, quality patient outcomes and positive staff satisfaction. * Collaborates with other nurse leaders, department directors and staff to achieve the strategic priorities of the organization and nursing department * Professional development, coaching and mentoring of nurse managers, motivates and leads a high-performing management team * Accountable for coordinating nursing and other assigned departments compliance with all pertinent TJC Standards, local, state and federal regulations * Responsible for annual operating and capital budgets * Provides guidance with implementation of clinical and financial goals o monitor the progress in each designated area o allocates resources to ensure achievement of goals The AVP reports directly to The CNO/Senior Vice President for Patient Care Services. Minimum requirements * Masters in nursing current * National certification * licensed as an RN in New York State * five years of recent management administrative experience The ideal candidate will be results focused, mission driven, charismatic, progressive thinking, accountable, flexible and approachable in daily work. St. Catherine Of Siena Smithtown NY

Managed Care Coordinator

St. Catherine Of Siena