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)
Summary:
As a member of the Patient Services Team, the Managed Care Assistant maintains on-gong tracking and documentation on referrals. The Managed Care Assistant ensures complete and accurate registration for referrals, including patient demographics,
insurance, and patient scheduling needs. The Managed Care Assistant follows referral guidelines to schedule and
follow-up on referrals. The Assistant will assist patients in resolving barriers to care, such as interpretation,
transportation, or understanding the referral process. The Managed Care Assistant obtains prior
authorizations and maintains communications with the primary care team,
patients, and referral partners.
Educational Requirements:
Two to Four years college, post high school training or
relevant work experience required. Relevant work experience may be substituted for education.
Experience Required:
A minimum of two years of work experience in a patient
services role, medical assistant role, or similar medical field required. Familiarity with Managed Care plans and
referral tracking/follow-up required. Proficiency with electronic medical systems and basic computer/data
entry skills required. Requires respectful and professional manner with patients,
staff, and providers; a high degree of customer service is required.
Professional Licensure/Special Skills and Certification Required:
None.
Reporting Relationship:
Reports directly to the Supervisor of Referrals, or as designated
EOE
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