Managed Care Coordinator jobs in Colorado

Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Colorado, CO FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medication utilization, formulary management, and ensuring cost-effective pharmacy services. The ideal candidate will bring a deep understanding of managed care principles, a proactive approach to problem-solving, and a commitment to optimizing pharmacy outcomes within a managed care environment.

    Preferred Qualifications:
    PharmD degree from an accredited pharmacy program
    Previous experience in Pharmacy Benefit Management (PBM) or Managed Care
    Knowledge of formulary development and management
    State pharmacy license in good standing
    Strong analytical and data interpretation skills
    Excellent communication and negotiation abilities
    Familiarity with healthcare regulations and compliance standards
    Collaboration experience with healthcare providers, payers, and pharmaceutical manufacturers
    Proficiency in utilizing pharmacy management software and tools
    Active participation in relevant professional organizations
    Dedication to staying informed about industry trends and innovations

    Responsibilities:
    Collaborate with healthcare stakeholders to implement and optimize pharmacy benefit programs
    Conduct formulary reviews and assessments to ensure cost-effective and evidence-based medication choices
    Monitor and analyze pharmacy utilization trends, identifying opportunities for cost savings and improved patient outcomes
    Provide expertise in drug utilization management and prior authorization processes
    Stay informed about industry regulations, guidelines, and emerging trends in managed care pharmacy
    If you are a passionate and experienced pharmacist with a background in PBM or Managed Care, we invite you to join our dynamic team dedicated to advancing healthcare through innovative and cost-effective pharmacy solutions. Apply now to contribute to the future of managed care pharmacy.
  • 23 Days Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Denver, CO FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
  • 24 Days Ago

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BIA - Technical Coordinator Dam Safety
  • Managed Business Solutions
  • Lakewood, CO FULL_TIME
  • Job Title: Technical Coordinator – Dam SafetyJob SummaryThis position assists the Branch Chief in the day-to-day operations of the Safety of Dams (SOD) Branch. Individual will have three years' minimu...
  • 8 Days Ago

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Managed Care Data Platform Manager
  • CommonSpirit Health
  • Englewood, CO FULL_TIME
  • Overview* CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-base...
  • Just Posted

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Care Coordinator
  • Total Care Connections
  • Colorado, CO FULL_TIME
  • Are you a compassionate professional with a knack for organization and a passion for helping others? Total Care Connections is looking for an empathetic and dedicated Care Coordinator to join our Phoe...
  • Just Posted

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Care Coordinator
  • Talem Home Care
  • Denver, CO FULL_TIME
  • We are hiring a Home Care Coordinator.Are you the perfect Talem Teammate? Do you have the skills, work ethic, and passion to help people around you succeed? Are you a strong relationship builder? Do y...
  • 1 Month Ago

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Managed Care Coordinator
  • Mindlance
  • Columbia, SC
  • Job Title: Managed Care Coordinator Job Location: Columbia, SC Top 3/5 Skills: · RN / Registered Nurse License · Chronic...
  • 6/11/2024 12:00:00 AM

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Managed Care Coordinator-Onsite Kansas City
  • AdventHealth
  • Maitland, FL
  • **AdventHealth -** **This position is in Kansas City** **All the benefits and perks you need for you and your family:** ...
  • 6/10/2024 12:00:00 AM

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Care Management, Care Coordinator, Utilization Management
  • Hackensack Meridian Health
  • Neptune, NJ
  • Description: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients ...
  • 6/10/2024 12:00:00 AM

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Case Manager (Care Coordinator)
  • Pacifica Hospital of the Valley
  • Los Angeles, CA
  • Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
  • 6/9/2024 12:00:00 AM

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Sales Manager/ Care Coordinator
  • Always Best Care Senior Services
  • Thousand Oaks, CA
  • Sales Manager / Care Coordinator Always Best Care, a National home care company, is currently looking for a seasoned, en...
  • 6/9/2024 12:00:00 AM

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Credentialing and Managed Care Coordinator
  • Texas Oncology
  • Richardson, TX
  • Overview: The US Oncology Network is looking for a Credentialing and Managed Care Coordinator to join our team at Texas ...
  • 6/8/2024 12:00:00 AM

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Case Manager (Care Coordinator)
  • Pacifica Hospital of the Valley
  • Los Angeles, CA
  • Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
  • 6/8/2024 12:00:00 AM

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office manager/ care coordinator
  • 5 Stars Home Care LLC
  • Alexandria, VA
  • Job Description Job Description Job Summary: Duties: Responsible for all areas of Operations; human resources, intakes, ...
  • 6/7/2024 12:00:00 AM

Colorado (/ˌkɒləˈrædoʊ, -ˈrɑːdoʊ/ (listen), other variants) is a state of the Western United States encompassing most of the southern Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains. It is the 8th most extensive and 21st most populous U.S. state. The estimated population of Colorado was 5,695,564 on July 1, 2018, an increase of 13.25% since the 2010 United States Census. The state was named for the Colorado River, which early Spanish explorers named the Río Colorado for the ruddy silt the river carried from the mountains. The...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$50,443 to $86,574

Managed Care Coordinator in New Orleans, LA
Health systems must meet the operational challenge of managing provider data for thousands of participating providers in their value-based care networks.
January 11, 2020
Managed Care Coordinator in Gainesville, FL
Many telehealth programs give patients easy access to any additional educational materials provided by their health plan or primary care provider.
December 23, 2019
Managed Care Coordinator in Houston, TX
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 issuesSupports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements.
December 27, 2019