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)
The Managed Care Coordinator completes insurance requirements and provides case management as needed for services performed in various patient seeing settings. The individual obtains and provides insurance benefit information to patients and patient care departments. The Managed Care Coordinator assists patients and providers with developing strategies for alternative options for non-covered services by communicating with the provider, patient, insurance carrier and Patient Assistance Counselor.
JOB QUALIFICATIONSÂ
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: High school diploma or equivalent. Successful completion of a medical terminology and an anatomy & physiology course, per departmental procedures, within one year of hire.
Preferred/Optional: Successful completion of a medical terminology and an anatomy & physiology course at time of hire. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program.
EXPERIENCE
Minimum Required: Two years’ experience in a medical business office or health care setting. Prior experience should include working with and obtaining insurance eligibility and benefit information.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: For positions hired within the dental centers: Basic Life Support (BLS) awarded by the American Heart Association within one year of hire.
Preferred/Optional: Basic Life Support (BLS) awarded by the American Heart Association at time of hire.
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