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)
Insurance Managed Care RN - UR/CM
Precedence, Inc., Rock Island, IL
Remote or Hybrid with Experience - Based Off Of Location
Full-Time Benefits
M-F, 8-5
The Managed Care RN Utilization/Case Manager, under the direction of the Director of Managed Care serves a key role in coordinating the patient’s/enrollees interdisciplinary providers/services to assess and effectively use resources and to track and minimize the inappropriate use of such resources while providing the right care at the right level at the right time. This role is responsible for utilization management and case management for patients/enrollees. This includes payment authorizations, clinical coordination, integration and facilitation of all care and services for the patient by all members of the health care team.
This role performs admission assessment, continued stay reviews all according to established criteria of third party carriers, and as found necessary on cases with third party payor review. Monitoring of plan of care to address physical and psychosocial needs, and provide problem solving assistance. Coordinates services, discharge planning, referrals to appropriate community agencies and assists with Advance Directives when appropriate. Responsible for reviewing and updating critical paths with healthcare team when applicable. Also, assessing, monitoring, analyzing and documenting resources utilized in the provision of patient care.
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#RYCJessi
Education:
Registered Nurse
Experience:
5 years of nursing experience
License(s)/Certification(s):
Registered Nurse – Illinois Licensed
Knowledge/Skills/Abilities:
#QC123
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