Managed Care Coordinator jobs in South Carolina
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)
Recently Added Managed Care Coordinator jobs
Managed Care Coordinator I
- LanceSoft, Inc.
-
Columbia, SC
CONTRACTOR
-
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes.
50% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. May initiate/coordinate discharge planning or alternative treatment plans as necessary and appropriate. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
20% Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
10% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions that consist of: intensive assessment/evaluation of condition, at risk education based on members identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
10% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. 1
0% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
Required Skills and Abilities:
Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes.
Preferred Software and Other Tools: Working knowledge of Microsoft Excel, Access or other spreadsheet/database software. Work Environment: Typical office environment. Employee may work from one's/out of one's home. May involve some travel within one's community. - 5 Days Ago
Coordinator, Managed Care II/CM-DM
- LanceSoft, Inc.
-
Columbia, SC
CONTRACTOR
- Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service r...
- 3 Days Ago
Managed Care Coordinator II/CM-DM
- SPECTRAFORCE
-
Columbia, SC
CONTRACTOR
- Job Title: Managed Care Coordinator IILocation: Columbia, SC. 29219 (Remote after 1 week onsite training. Have to come in periodically for meetings/classes as needed)Duration: 3 months assignment with...
- 6 Days Ago
Telephonic Medical Case Manager (Workers' compensation)
- TRISTAR MANAGED CARE INC
-
Summerville, SC
FULL_TIME
- Please make sure that you complete all of the questions and navigate to the end of the application to sign the application. This will be a remote position. Preferred experience in New York, New Jersey...
- Just Posted
Managed Care Licensing and Credentialing Liaison
- Medical Services of America
-
Lexington, SC
FULL_TIME
- Our Credentialing Support Specialist will be responsible to complete, submit and track credentialing data while demonstrating high attention to detail and accuracy with emphasis on timeliness. We are ...
- 1 Day Ago
Client Care Coordinator
- Jenkins Home Care
-
Charleston, SC
FULL_TIME
- NOW HIRING! Client Care CoordinatorLocation: Charleston, SCAre you passionate about making a positive impact on people's lives? Jenkins Home Care is actively seeking a dedicated and compassionate indi...
- 1 Month Ago
Managed Care Coordinator jobs at Popular Companies
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
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
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
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
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
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
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
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
About South Carolina
South Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the Southeastern United States and the easternmost of the Deep South. It is bordered to the north by North Carolina, to the southeast by the Atlantic Ocean, and to the southwest by Georgia across the Savannah River.
South Carolina became the eighth state to ratify the U.S. Constitution on May 23, 1788. South Carolina became the first state to vote in favor of secession from the Union on December 20, 1860. After the American Civil War, it was readmitted into the United States on June 25, 1868.
South Carolina is the 40th most extensive and 23...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$46,685 to $80,123
Most Popular Cities in South Carolina for Managed Care Coordinator Jobs
What does a Managed Care Coordinator do?
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