Managed Care Supervisor jobs in South Carolina
Managed Care Supervisor supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Being a Managed Care Supervisor experienced in utilization review techniques and protocols. Requires a bachelor's degree. Additionally, Managed Care Supervisor typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. The Managed Care Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. To be a Managed Care Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. (Copyright 2024 Salary.com)
Recently Added Managed Care Supervisor 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
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
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
Home Care: Care Coordinator Supervisor
- Live Long Well Care Southeast
-
Greenville, SC
FULL_TIME
- Live Long Well Care of Greenville is now accepting applications for a Care Coordinator to represent the Agency as a front line customer service liaison between patient/clients & caregivers. Must be av...
- 18 Days Ago
Managed Care Supervisor jobs at Popular Companies
Child Care Supervisor
- Stratton Mountain
-
Stratton Mountain, VT
- Please note, this position is located at Stratton Mountain Resort in Stratton Mountain, VT Year Round At Stratton, we ar...
- 6/11/2024 12:00:00 AM
Animal Care Supervisor
- Petco Health and Wellness Company, Inc.
-
Miami, FL
- The Operations Leader Animal Care promotes and ensures the efficient and effective operations of the Companion Animal De...
- 6/11/2024 12:00:00 AM
Residential Care Supervisor
- THE CENTERS FOR HABILITATION
-
Gilbert, AZ
- Job Description Job Description Direct Care Supervisor II (Tempe) 3196 WHO WE ARE: TCH has been serving the needs of ind...
- 6/11/2024 12:00:00 AM
Care Supervisor
- ComForCare
-
Lansdale, PA
- Benefits: Bonus based on performance Competitive salary Flexible schedule Paid time off Wellness resources Full job desc...
- 6/7/2024 12:00:00 AM
Animal Care Supervisor
- Petco
-
Rochester, MN
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/6/2024 12:00:00 AM
Direct Care Supervisor
- Mosaic
-
Axtell, NE
- If making a positive impact in the lives of others is a constant on your to-do list — you’ll LOVE working with a team th...
- 6/6/2024 12:00:00 AM
Direct Care Supervisor
- Mosaic
-
Kearney, NE
- If making a positive impact in the lives of others is a constant on your to-do list — you’ll LOVE working with a team th...
- 6/6/2024 12:00:00 AM
Animal Care Supervisor
- Petco
-
Wausau, WI
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/3/2024 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 Supervisor jobs
$72,196 to $99,630
Most Popular Cities in South Carolina for Managed Care Supervisor Jobs
What does a Managed Care Supervisor do?
Managed Care Supervisor in Columbia, SC
The Supervisor Business Services of Government Billing and Collections will be responsible for the overall AR management of all government inventory.
January 02, 2020
Managed Care Supervisor in Colorado Springs, CO
In Service to Our Community is achieved through streamlined, coordinated and comprehensive high-quality, compassionate care close to home.
February 15, 2020
Managed Care Supervisor in Portland, ME
· Minimum one year resolving claims issues with Payer Relations representatives to handle managed care contract implications.
February 19, 2020