Pediatric Managed Care Coordinator

Extraordinary Home Care; Uniondale (NY); On-site; USD 45,000 - 47,000; Full time

Benefits offered by this job

Excellent individual/family benefits

Generous paid time off

Life insurance

Flexible spending accounts

Job summary

St. Mary’s Healthcare System for Children in Uniondale, NY is seeking a Managed Care Coordinator to support the planning, implementation, and coordination of managed care activities for an assigned team.

This role ensures compliance with regulatory guidelines and supports certification processes. You will liaise with the managed care department and field staff while assisting with enrollment, authorizations, and monthly reporting.

Qualifications

• Associates Degree required, Masters in Health Care preferred.
• Minimum of 1 year health care experience, managed care experience preferred.
• Experience with and understanding of New York State health care regulations, policies and provider reimbursement.
• Proficiency in word processing and spreadsheet applications.
• Excellent communication, planning, and organization skills.

Responsibilities

• Assist Managed care department with securing necessary summaries, documentation and insurance information.
• Act as liaison for the managed care department and staff.
• Assist with completion of open enrollment and insurance verification and updating of authorizations for Managed Care Team.
• Provide coverage for Managed Care Team in staffing shortages, including authorization submissions and follow-up with insurers.
• Update Managed Care Census and notify field clinicians about auth reviews and deadlines.
• Assist with securing Initial Authorization for new admissions as needed.
• Prepare monthly reports for managed care admissions, payments, and analyses.
• Maintain the managed care resource library (plans, materials).
• Support utilization management by monitoring insurance coverage for daily admissions.
• Prepare managed care in-service material for staff.
• Coordinate programs aligned with managed care strategy and research projects.
• Develop managed care policies and procedures.
• Perform clerical tasks as needed.

Skills

Communication skills

Planning

Organization

Education

Associates Degree

Masters in Health Care

Tools

Word processing

Spreadsheets

Job description

St. Mary’s Healthcare System for Children in Uniondale, NY is seeking a Managed Care Coordinator to support the planning, implementation, and coordination of managed care activities for an assigned team.

This role ensures compliance with regulatory guidelines and supports certification processes. You will liaise with the managed care department and field staff while assisting with enrollment, authorizations, and monthly reporting.