managed care coordinator

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members&rsquo; health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.
The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and
education for members through the use of care management tools and resources.
Key Responsibilities<ul><li>
Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member&rsquo;s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member&rsquo;s benefit plan and available</li><li>
internal and external programs/services.</li><li>
Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.</li><li>
Coordinates and implements assigned care plan activities and monitors care plan progress.</li><li>
Enhancement of Medical Appropriateness and Quality of Care: - Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.</li><li>
Identifies and escalates quality of care issues through established channels.</li><li>
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member&rsquo;s benefits and/or healthcare needs.</li><li>
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.</li><li>
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.</li><li>
Helps member actively and knowledgably participate with their provider in healthcare decision-making.</li></ul><ul><li>
Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.</li></ul>
Remote Work Expectations<ul><li>
This is a remote role; candidates must have a dedicated workspace free of interruptions</li><li>
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.</li></ul>
Required Qualifications<ul><li>2 years experience in behavioral health, social services or appropriate related field equivalent to program focus</li><li>Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually</li><li>Excellent analytical and problem-solving skills</li><li>Effective communications, organizational, and interpersonal skills</li><li>Ability to work independently</li><li>Proficiency with standard corporate software applications, including MS Word, Excel,</li></ul>
Outlook and PowerPoint, as well as some special proprietary applications.<ul><li>Efficient and Effective computer skills including navigating multiple systems and keyboarding</li></ul>
Must possess reliable transportation and be willing and able to travel up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy
Preferred<ul><li>Case management and discharge planning experience</li><li>Managed Care experience preferred
</li></ul>Education
<ul><li>Bachelor's degree or non-licensed master level clinician required with either degree being in behavioral health or human services (psychology, social work, marriage and family therapy, counseling)</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$21.10 - $44.99
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 05/22/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Case Management Coordinator, Assessor Team

Health Services Management

<div>
 RN MDS Coordinator &ndash; Sign-On Bonus
 
 
 Bear Creek Nursing &amp; Rehab Center
 
 
 📍 8041 State Road 52, Hudson, FL 34667
 
 
 Full-Time | Monday&ndash;Friday | Day Shift | Limited Weekend Rotation
 
 
 Sign-On Bonus + Relocation Assistance Available
 
 
 Work Today, Get Paid Today &ndash; Daily Pay Available
 
 
 Looking for a High-Impact MDS Role Where Your Expertise Matters?
 
 
 Bear Creek Nursing &amp; Rehab Center is seeking an experienced RN MDS Coordinator who brings both clinical strength and reimbursement expertise.
 
 
 This is a high-level, hands-on role for someone who understands the full scope of MDS, from PDPM and Quality Measures to Managed Care coordination and case management.
 
 
 If you&rsquo;re confident in your ability to drive reimbursement accuracy, influence clinical outcomes, and lead interdisciplinary collaboration, we want to connect with you.
 
 
 
 Why This Opportunity Stands Out
 
 
 
 <ul>
 <li>
 Sign-On Bonus + Relocation Assistance Available
 </li>
 <li>
 Monday&ndash;Friday Schedule &ndash; Better Work-Life Balance
 </li>
 <li>
 Daily Pay &ndash; Access Your Pay When You Need It
 </li>
 <li>
 Competitive Compensation Based on Experience
 </li>
 <li>
 Medical, Dental &amp; Vision Insurance
 </li>
 <li>
 401(k) with Employer Contributions
 </li>
 <li>
 Paid Time Off + Paid Holidays
 </li>
 <li>
 Company-Paid Life Insurance
 </li>
 <li>
 Supportive Leadership &amp; Collaborative Clinical Team
 </li>
 <li>
 Growth Opportunities within a Multi-Facility Network
 
 
 </li>
 </ul>
 
 What You&rsquo;ll Own
 
 
 
 <ul>
 <li>
 Lead and manage the full MDS/RAI process (assessment, coding, review, submission)
 </li>
 <li>
 Ensure accurate PDPM coding and reimbursement optimization
 </li>
 <li>
 Oversee case management functions, including payer communication and care coordination
 </li>
 <li>
 Communicate directly with Managed Care Organizations regarding authorizations and discharge planning
 </li>
 <li>
 Monitor, analyze, and improve CMS Quality Measures (QMs)
 </li>
 <li>
 Track and influence Case Mix Index (CMI) trends
 </li>
 <li>
 Collaborate with the interdisciplinary team on care planning and outcomes
 </li>
 <li>
 Educate staff on documentation standards and compliance
 </li>
 <li>
 Support survey readiness, audits, and QAPI initiatives
 
 
 </li>
 </ul>
 
 What We&rsquo;re Looking For (Required)
 
 
 
 <ul>
 <li>
 Active Florida RN license (required)
 </li>
 <li>
 2+ years MDS experience in a Skilled Nursing Facility (required)
 </li>
 <li>
 Case Management experience within SNF (required)
 
 
 </li>
 </ul>
 
 Strong knowledge of:
 
 
 
 <ul>
 <li>
 PDPM reimbursement model
 </li>
 <li>
 MDS 3.0 &amp; RAI process
 </li>
 <li>
 Managed Care &amp; payer communication
 </li>
 <li>
 CMS Quality Measures (QMs)
 </li>
 <li>
 Proven ability to analyze data, drive outcomes, and ensure compliance
 </li>
 <li>
 Strong leadership, organization, and communication skills
 
 
 </li>
 </ul>
 
 Preferred
 
 
 
 <ul>
 <li>
 Experience with PointClickCare (PCC) or similar EMR
 </li>
 <li>
 RAC-CT Certification
 </li>
 <li>
 Experience with reimbursement audits and CMI management
 
 
 </li>
 </ul>
 
 What Makes You a Great Fit
 
 
 
 <ul>
 <li>
 You understand that MDS drives both clinical quality and financial performance
 </li>
 <li>
 You&rsquo;re confident working independently while leading cross-functional teams
 </li>
 <li>
 You take ownership of accuracy, timelines, and results
 
 
 </li>
 </ul>
 
 Schedule
 
 
 
 Monday&ndash;Friday | Day Shift
 
 
 Occasional weekend support as needed
 
 
 Apply Today &ndash; Interviews Happening This Week
 
 
 
 Equal Opportunity Employer
 
 
 
 Bear Creek Nursing &amp; Rehab Center is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
 
 
 
 Job Disclaimer
 
 
 
 This job description is not intended to be all-inclusive. Duties may be modified based on operational needs.
 
 
 
 Background Screening
 
 
 
 All background screenings will be completed through:
 
 
 https://info.flclearinghouse.com
 
 
 
 #INDBC123
 
</div>

RN, MDS Coordinator

Warthan Dermatology

Job Summary We are seeking a dedicated and detail-oriented Biologics Coordinator to join our dynamic healthcare team. In this vital role, you will oversee the coordination and management of biologic therapies, ensuring seamless communication between patients, healthcare providers, and insurance companies. Your energetic approach will help facilitate efficient treatment processes, maintain compliance with healthcare regulations, and support patient care excellence. If you thrive in a fast-paced environment and are passionate about advancing patient outcomes through meticulous coordination, this opportunity is perfect for you!Responsibilities<ul><li>Manage the scheduling, tracking, and documentation of biologic therapy treatments for patients </li><li>Verify insurance coverage and benefits, including managed care plans, to ensure timely authorization and reimbursement </li><li>Collaborate with medical offices to gather necessary medical records, prior authorizations, and treatment documentation </li><li>Ensure compliance with HIPAA regulations by handling sensitive patient information securely and confidentially </li><li>Assist with medical coding processes such as CPT (Current Procedural Terminology), ICD-9 (International Classification of Diseases, Ninth Revision), ICD-10 (Tenth Revision), and other ICD coding systems to support accurate billing </li><li>Coordinate with healthcare providers to verify insurance eligibility, perform insurance verification, and facilitate claims processing </li><li>Maintain detailed records of all treatment activities, medical records, and correspondence related to biologic therapies</li></ul>Requirements<ul><li>Prior experience in a medical office setting or healthcare environment is highly preferred </li><li>Strong knowledge of medical terminology, medical records management, and medical coding practices including CPT, ICD-9, ICD-10, and ICD coding systems </li><li>Familiarity with managed care processes and insurance verification procedures </li><li>Experience working with HIPAA regulations to ensure patient privacy and data security </li><li>Excellent organizational skills with attention to detail in managing complex documentation and schedules </li><li>Ability to communicate effectively with patients, providers, insurance companies, and internal teams </li><li>Nice-to-have: dental office experience or additional background in medical office administration</li></ul>Join us as a Biologics Coordinator and play a crucial role in delivering exceptional patient care through precise coordination and comprehensive understanding of healthcare processes. Your proactive energy will drive efficiency and support our mission to improve health outcomes!Pay: From $13.00 per hourBenefits:<ul><li>401(k)</li><li>Health insurance</li><li>Paid time off</li></ul>Work Location: In person

Biologics Coordinator

Harborview Health Systems

<div><h1 class="jobSectionHeader">MDS Coordinator - RN</h1>
Top pay and benefits!
Who we are
As a faith-based organization, our mission is simple but powerful: to care for the caregiver so they can in turn care for our residents.
We offer top pay and benefits in a positive work environment.
The Opportunity
We are currently seeking an experienced MDS Coordinator to lead the clinical assessment and reimbursement process. In this essential role, you will manage all aspects of the Minimum Data Set (MDS) assessment process to ensure accurate documentation, optimal reimbursement, and compliance with regulatory requirements. You will collaborate closely with interdisciplinary team members to develop person-centered care plans and advocate for resident needs.
What You Will Do<ul><li>
Complete and submit timely and accurate MDS assessments</li><li>
Select appropriate ARDs and diagnosis codes to ensure accurate PDPM classification and reimbursement</li><li>
Monitor PDPM components, validate supporting documentation, and ensure compliance with CMS requirements</li><li>
Coordinate and lead care planning across Nursing, Therapy, Social Services, Dietary, and Activities departments</li><li>
Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review, monthly Triple Check, and care plan conferences</li><li>
Utilize programs such as PCC, SimpleLTC, NetHealth, Teams, IQIES, Myers &amp; Stauffer, Power DMS, and Google Sheets</li><li>
Other duties as assigned</li></ul>
What You Must Have<ul><li>
Active RN license in good standing in the state of practice</li><li>
Experience in skilled nursing and long term care</li><li>
Experience using MDS tracking and assessment tools such as SimpleLTC and PCC is a plus</li></ul>
Benefits - Things we want you to know<ul><li>
We offer a comprehensive benefits package, including:<ul><li>
401(k) managed by Merrill Lynch</li><li>
DailyPay</li><li>
Health Insurance with Anthem Blue Cross or Cigna</li><li>
Dental, Life, Vision, and Disability Insurance</li><li>
Paid Time Off</li></ul></li></ul></div>

MDS Coordinator RN

Ascentria Care Alliance

<div>Worcester, MA | Senior Care Finance 
$37&ndash;$39 per hour | Full Time

Help Support the Systems Behind Exceptional Care

At Ascentria Care Alliance, our mission is to empower people, strengthen communities, and provide compassionate care to those who need it most.

Behind every resident receiving quality care is a team ensuring the financial and operational systems run smoothly. The Central Billing Coordinator plays a critical role in supporting the billing operations for five Skilled Nursing Facilities, helping ensure claims are processed accurately and facilities receive the financial support needed to continue delivering outstanding care.

If you are detail-oriented, organized, and experienced in Skilled Nursing billing, this is an opportunity to join a collaborative, mission-driven team.

What You'll Do

In this role, you will help manage the billing process across multiple facilities, ensuring claims are submitted accurately and collections are followed through.

Key responsibilities include:
<ul>
<li>Processing billing for five Skilled Nursing Facilities 
<ul><li>Verifying census and billing data within PointClickCare (PCC)</li><li>Entering ancillary services and ensuring authorizations are complete</li><li>Preparing and submitting electronic claims for Medicare, Medicaid, and Managed Care</li><li>Ensuring coinsurance claims are billed accurately</li><li>Managing collections and performing follow-up on outstanding balances</li><li>Posting cash payments and assisting with monthly billing cycles</li><li>Collaborating with facility administrators and business office liaisons</li><li>Participating in billing and collections meetings</li></ul></li>
</ul>
What We're Looking For

Required Experience
<ul>
<li>3&ndash;5 years of Skilled Nursing Facility billing and collections experience 
<ul><li>Strong understanding of Medicare, Medicaid, and Managed Care billing processes</li><li>Basic accounting skills</li><li>Ability to manage multiple systems and priorities simultaneously</li></ul></li>
</ul>
Additional Strengths
<ul>
<li>Highly organized and detail-oriented 
<ul><li>Strong communication and collaboration skills</li><li>Ability to problem solve and resolve billing issues proactively</li><li>Comfortable working in a fast-paced healthcare environment</li></ul></li>
</ul>
Education: 
High School Diploma required; Associate Degree or additional coursework preferred.

Work Environment
<ul>
<li>In-person position based in Worcester, MA 
<ul><li>Fast-paced healthcare finance environment</li><li>Collaboration with multiple Skilled Nursing Facilities</li></ul></li>
</ul>
Compensation

 $37&ndash;$39 per hour

Competitive compensation aligned with the nonprofit healthcare market.

Why Join Ascentria

Ascentria Care Alliance is a mission-driven nonprofit organization committed to strengthening communities and supporting vulnerable populations. Our work is rooted in compassion, integrity, and service.

Every role contributes to helping others live with dignity and support.

Apply today and join a team that helps keep care moving forward.</div>

Central Billing Coordinator

Encore Wound Care

Job Overview The Clinical Document Coordinator is responsible for supporting provider credentialing and compliance activities by maintaining accurate records, monitoring licensure and certification expirations, and serving as a liaison between providers and the credentialing company. This role ensures all provider documentation is current, organized, and compliant with regulatory and organizational requirements.Responsibilities<ul><li>Licensure &amp; Certification Tracking</li><li>Monitor and track expiration dates for all provider licenses, certifications, and registrations</li><li>Proactively notify providers of upcoming expirations and renewal requirements and collect updated documentation</li><li>Maintain accurate and up-to-date records of all licensure documentation</li><li>Verify insurance coverage and perform insurance eligibility checks using managed care protocols</li><li>Prepare and maintain accurate medical records in compliance with HIPAA regulations and organizational policies</li><li>CAQH Profile Management</li><li>Create, update, and maintain provider profiles within CAQH</li><li>Ensure all attestations are completed on time</li><li>Upload and verify accuracy of provider documents within the CAQH system</li><li>Document Management &amp; Compliance</li><li>Organize and maintain digital files for all provider credentials, including licenses, malpractice insurance, DEA, and certifications</li><li>Ensure all required documentation is current and audit-ready</li><li>Assist with internal and external audits by providing requested documentation</li><li>Credentialing Coordination</li><li>Serve as the primary point of contact between providers and the credentialing company</li><li>Track credentialing application statuses and follow up as needed</li><li>Communicate any missing or incomplete items to providers promptly</li><li>Administrative Support</li><li>Maintain tracking logs and spreadsheets related to credentialing and compliance</li><li>Assist with onboarding new providers by gathering and organizing required documentation</li><li>Support ongoing compliance initiatives and process improvements</li></ul>Skills<ul><li>2+ years of administrative experience, preferably in healthcare or credentialing</li><li>Experience with CAQH and provider credentialing processes strongly</li><li>Experience with managed care processes and insurance verification procedures</li><li>Familiarity with HIPAA regulations to safeguard patient privacy and confidentiality</li><li>Previous medical office experience preferred for seamless integration into clinical workflows</li><li>Excellent organizational skills with attention to detail in record-keeping and documentation</li><li>Ability to communicate effectively with healthcare providers and internal teams, and 3rd party groups</li></ul>This role is perfect for motivated individuals eager to grow within the healthcare administration field. Join us in delivering exceptional patient care through efficient administrative support!Pay: $18.00 - $22.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Clinical Document Coordinator

Aviata Health Group

<div>Job Title: Business Office Coordinator 
Company: Aviata Health Group
Experience: 1-2 years 
Aviata Health Group is seeking a detail-oriented and organized Business Office Coordinator to support the financial and administrative operations of our center. This role is essential in ensuring accurate billing, resident fund management, and compliance with regulatory requirements while providing excellent support to residents, families, and vendors.
Key Responsibilities:<ul><li>
Manage and reconcile Resident Trust Funds</li><li>
Oversee resident/patient insurance premium payments for center-managed income</li><li>
Manage census entry, reporting, and reconciliation</li><li>
Participate in IDT Utilization Review processes and reporting for upcoming LTC conversions and potential payer issues</li><li>
Manage the collection and flow of Medical Pending documentation</li><li>
Assist with Medicaid Pending payer discussions and upcoming conversions</li><li>
Submit and obtain required Level of Care documentation for Medicaid Pending cases</li><li>
Apply for disability and Representative Payee status on behalf of residents/patients as needed</li><li>
Ensure timely completion and submission of annual Representative Payee reporting to Social Security</li><li>
Ensure all LTC Medicaid-eligible residents receive entitled Personal Needs Allowance (PNA) from the State and Social Security</li><li>
Assist with private collections and payment follow-up</li><li>
Manage the flow of payer and billing information between the center and billing office</li><li>
Manage, reconcile, and replenish facility petty cash</li><li>
Process vendor payment requests</li><li>
Complete AHCA Nursing Home Utilization Reporting, including monthly inpatient census days</li><li>
Apply for Medicare Part B and Part D on behalf of residents/patients as needed</li><li>
Assist residents, families, and vendors with payment-related concerns</li><li>
Manage disenrollment's and ensure proper documentation and follow-through</li></ul>
Qualifications:<ul><li>
Previous experience in healthcare business office, billing, or administrative support preferred</li><li>
Knowledge of Medicaid, Medicare, and insurance processes is a plus</li><li>
Strong organizational and reconciliation skills with attention to detail</li><li>
Excellent communication and interpersonal skills</li><li>
Ability to manage multiple priorities in a fast-paced environment</li><li>
Proficiency in Microsoft Office and healthcare systems preferred</li></ul>
Why Join Aviata Health Group?<ul><li>
Supportive team environment</li><li>
Opportunities for growth and development</li><li>
Competitive compensation and benefits</li></ul>
Apply today to become a vital part of our team and help support quality care through strong financial operations.
We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.
https://info.flclearinghouse.com/</div>

Business Office Coordinator

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