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)
Job Summary:
Under the general direction and leadership of the Vice President for Finance; plans, organizes and directs the operational functions of the Medical Center as they relate to managed care. Develops, interprets and implements policies and procedures to create and maintain an effective managed care program with maximum reimbursement rates. This position carries primary administrative responsibilities for the managed care contracting efforts of the Medical Center as well as other corporate entities as needed. Demonstrates the Standards for Service Excellence, so that these standards represent minimum accepted behavior. Plan, direct and coordinate the operations of the Managed Care. Manage staff for optimum performance.
Department: Managed Care
Location: Englewood Cliffs, NJ
Status: Full-Time
Shift:Day
Hours: 9:00am to 5:00pm
Job Essentials: The ideal candidate will meet the following requirements and competencies.
Education Requirements:
Englewood Health, one of New Jersey’s leading hospitals and healthcare networks, delivers nationally recognized inpatient and outpatient care through its hospital and network of physician practices, urgent care centers, and imaging centers. Englewood Hospital, founded in 1890, consistently earns high marks for clinical excellence and patient safety. It is recognized as a 2022-23 Best Regional Hospital by US News & World Report, holds the Leapfrog Hospital Safety Grade ‘A’ (spring 2023), and was named a Leapfrog Top Teaching Hospital (2022). Englewood Hospital is nationally recognized for nursing excellence, earning a fifth consecutive designation by the Magnet Recognition Program in 2021. The Englewood Health Physician Network—a coordinated network of more than 600 office-based and hospital-based providers—offers primary care, specialty care, and urgent care at more than 140 locations in five counties across northern New Jersey. Areas of clinical excellence offered by the health system include cardiac surgery and cardiac care, cancer care, orthopedic surgery, primary care, spine surgery, vascular surgery, and women’s health, as well as bloodless medicine and surgery and minimally invasive robotic surgery. Englewood Health’s focus on health equity and population health encompasses outreach to underserved communities to enhance individual and public health, prevent disease, support lifelong wellness, reduce the burden of mental health challenges and substance use disorders, and meet the cultural, social, and holistic needs of specific populations. With its high-quality, culturally sensitive inpatient care, outpatient services, and community health and wellness programs, Englewood Health delivers a healthcare experience that puts patients at the center.
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