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Guidance Care HMO

Managed Care Liaison

Lakewood, NJ · On-site

Guidance Care HMO is looking to hire Full Time employees in our Liaison Department. Our Liaison Department assists nursing homes with various billing inquiries and other issues related to Managed ...

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What is an HMO?

An HMO (Health Maintenance Organization) job typically refers to a role within a healthcare organization that provides managed care services to patients. Employees in HMO roles may work in various capacities, such as case management, claims processing, provider relations, or patient coordination. Their primary responsibility is to ensure efficient healthcare delivery while managing costs and maintaining compliance with healthcare regulations.

What are the typical responsibilities of an HMO medical officer on a daily basis?

As an HMO Medical Officer, your daily tasks often include reviewing patient medical records for pre-authorization or claims, consulting with physicians and healthcare providers on case management, and conducting medical audits to ensure compliance with policies. You’ll also participate in utilization review meetings and help develop clinical guidelines to improve care quality and operational efficiency. This role is highly collaborative, requiring regular interaction with both clinical and administrative staff. By balancing clinical expertise with healthcare management, you play a key role in delivering effective and sustainable patient care within the HMO structure.

What are the key skills and qualifications needed to thrive in the HMO position, and why are they important?

To thrive as an HMO (Health Maintenance Organization) Medical Officer, a medical degree with appropriate licensure and experience in clinical medicine are essential. Familiarity with healthcare management systems, medical auditing tools, and utilization review protocols are typically required. Strong analytical thinking, decision-making, and interpersonal communication skills help HMO Medical Officers navigate complex cases and work collaboratively with providers and administrative teams. These competencies are vital for ensuring high-quality, cost-effective patient care and compliance with organizational standards.

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States with the most job openings for Hmo jobs include:

What job categories do people searching Hmo jobs look for?

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Infographic showing various Hmo job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 93% Full Time, 5% Part Time, and 1% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution.

HMO Coordinator

Larkin Community Hospital

South Miami, FL • On-site

Full-time

Re-posted 5 hours ago

Job description

About the Role:

The HMO Coordinator plays a critical role in managing and facilitating the operations of Health Maintenance Organization (HMO) plans to ensure seamless healthcare delivery to members. This position involves coordinating between healthcare providers, insurance companies, and members to optimize service quality and compliance with regulatory standards. The coordinator will oversee enrollment processes, claims management, and provider network maintenance to support efficient plan administration. By analyzing data and resolving issues promptly, the HMO Coordinator helps improve member satisfaction and operational effectiveness. Ultimately, this role ensures that all aspects of the HMO plan function cohesively to meet organizational goals and regulatory requirements.

Minimum Qualifications:

  • Strong knowledge of HMO structures, healthcare regulations, and insurance claims processes.
  • Proficiency in using healthcare management software and Microsoft Office Suite.
  • Excellent communication and organizational skills with the ability to manage multiple tasks simultaneously.

Preferred Qualifications:

  • Familiarity with HIPAA regulations and compliance standards.
  • Demonstrated ability to analyze healthcare data and generate actionable insights.
  • Experience working in a fast-paced healthcare or insurance environment.

Responsibilities:

  • Manage member enrollment and eligibility verification processes to ensure accurate and timely access to HMO services.
  • Coordinate communication between healthcare providers, insurance carriers, and members to resolve inquiries and issues related to coverage and claims.
  • Maintain and update provider network information, ensuring compliance with contractual agreements and regulatory standards.
  • Monitor claims processing and assist in resolving discrepancies or denials to facilitate prompt reimbursement.
  • Prepare reports and analyze data related to plan utilization, member satisfaction, and operational performance to support continuous improvement initiatives.

Skills:

The HMO Coordinator utilizes strong organizational and communication skills daily to liaise effectively between members, providers, and insurance entities, ensuring clear and accurate information exchange. Analytical skills are essential for reviewing claims data, identifying discrepancies, and supporting decision-making processes that enhance operational efficiency. Proficiency with healthcare management software and data reporting tools enables the coordinator to maintain accurate records and generate insightful reports. Problem-solving abilities are applied to resolve coverage issues and improve member satisfaction. Additionally, knowledge of healthcare regulations and compliance ensures that all activities adhere to legal and ethical standards, safeguarding both the organization and its members.

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About Larkin Community Hospital

Sourced by ZipRecruiter

At Larkin, we have been serving the health care needs of South Miami, Hialeah, and the surrounding communities for more than 40 years. We take pride in the continuing tradition of caring. We remain dedicated to providing excellent medical care with the personal touch and convenience that only a community hospital offers.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

South Miami, FL, US

Year founded

1969

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