Managed Care Supervisor jobs in Columbia, SC

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)

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Managed Care Coordinator I
  • Spectraforce Technologies
  • Columbia, SC FULL_TIME
  • Job Title: Managed Care Coordinator I
    Location: Columbia, SC. 29229 (Remote after 1 week onsite training)
    Duration: 3 months assignment with possible extension.
    Shift: Mon-Fri, 8:30 am to 5:00 pm.
    Payrate: $30/hr.

    Summary:

    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.

    Responsibilities:
    • 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.
    • 10% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
    Required Education: Associate Degree - Nursing or Graduate of Accredited School of Nursing or Master's degree in Social Work, Psychology, or Counseling.
    Required Work Experience: 2 years clinical experience.
    Required License and Certificate: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire.

    Preferred Education: Bachelor's degree- Nursing.
    Preferred Work Experience: 7 years-healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery.
    Languages: English.

    About Us: Established in 2004, SPECTRAFORCE is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams.
    We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation.
    SPECTRAFORCE is built on a concept of "human connection," defined by our branding attitude of NEWJOBPHORIA, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at:

    Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances. Additional benefits SPECTRAFORCE offers to the eligible employees include commuter benefits, 401K plan with matching and a referral bonus program. SPECTRAFORCE offers unpaid leave as well as paid sick leave when required by law.

    EEOC: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at if you require reasonable accommodation.

    CPRA: The Company is committed to complying with the California Privacy Rights Act ("CPRA") effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting .

    SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at nahr@spectraforce.com if you require reasonable accommodation.

     

  • 1 Month Ago

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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 ...
  • 11 Days Ago

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Managed Care Coordinator II (31995382)
  • Professional Management Enterprises
  • Columbia, SC FULL_TIME
  • Seeking anRNwithManaged Care and Utilization Managementexperience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requir...
  • 20 Days Ago

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Managed Care Coordinator I (31609005)
  • Professional Management Enterprises
  • Columbia, SC FULL_TIME
  • Seeking anRNwithManaged Care and Utilization Managementexperience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requir...
  • 20 Days Ago

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Clinical Supervisor (RN)
  • Agape Care Group
  • Blythewood, SC FULL_TIME
  • Overview: Join Our Team as an RN Clinical SupervisorWe are looking for impeccable leaders to join our team who are committed to creating meaningful patient experiences. As a clinical supervisor, you'l...
  • 1 Month Ago

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Clinical Supervisor (RN)
  • Agape Care Group
  • West Columbia, SC FULL_TIME
  • Overview: Join Our Team as an RN Clinical SupervisorWe are looking for impeccable leaders to join our team who are committed to creating meaningful patient experiences. As a clinical supervisor, you'l...
  • 1 Month Ago

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0 Managed Care Supervisor jobs found in Columbia, SC area

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Travel Physical Therapist-Georgia
  • Hiring Now!
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/17/2024 12:00:00 AM

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Custodial Supervisor
  • State of South Carolina
  • Columbia, SC
  • Salary: $41,258.00 - $51,572.00 Annually Location : Richland County, SC Job Type: FTE - Full-Time Job Number: STA00237PO...
  • 4/15/2024 12:00:00 AM

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Travel Physical Therapist-Oregon
  • Hiring Now!
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/15/2024 12:00:00 AM

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Travel Physical Therapist-Nebraska
  • Hiring Now!
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/15/2024 12:00:00 AM

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Travel Physical Therapist-Iowa
  • Hiring Now!
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/15/2024 12:00:00 AM

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Travel Physical Therapist-Tennessee
  • Hiring Now!
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/15/2024 12:00:00 AM

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Travel Physical Therapist-Wisconsin
  • Ati Physical Therapy
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/15/2024 12:00:00 AM

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Travel Physical Therapist-Pennsylvania
  • Hiring Now!
  • Columbia, SC
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/15/2024 12:00:00 AM

One of Columbia's more prominent geographical features is its fall line, the boundary between the upland Piedmont region and the Atlantic Coastal Plain, across which rivers drop as falls or rapids. Columbia grew up at the fall line of the Congaree River, which is formed by the convergence of the Broad River and the Saluda River. The Congaree was the farthest inland point of river navigation. The energy of falling water also powered Columbia's early mills. The city has capitalized on this location which includes three rivers by christening itself "The Columbia Riverbanks Region". Columbia is lo...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Supervisor jobs
$70,588 to $97,419
Columbia, South Carolina area prices
were up 1.5% from a year ago

Managed Care Supervisor in Austin, TX
The F/MCC Supervisor will ensure adequate team staffing, team training, participates in staff hiring and performance reviews.
December 07, 2019
Managed Care Supervisor in Lowell, MA
The individual will have a focus on assessing, interpreting, and analyzing the impact of utilization of services within the Winchester PHO to maximize performance in the managed care contracts that support the BILH Network.
February 18, 2020
Managed Care Supervisor in Montgomery, AL
The hospital offers a full range of medical services including maternity care and a Level IIB Special Care Nursery.
January 15, 2020