Top Managed Care Executive jobs in Columbia, SC
Top Managed Care Executive plans and directs all aspects of an organization's managed care function. Responsible for directing and implementing managed care systems for healthcare facilities. Being a Top Managed Care Executive requires a bachelor's degree. Typically reports to a top management. The Top Managed Care Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Managed Care Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Recently Added Top Managed Care Executive jobs
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 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. - 2 Months Ago
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 ...
- 25 Days Ago
Account Executive - Hospice
- Agape Care Group
-
Columbia, SC
FULL_TIME
- Overview Join our team as a Hospice Account ExecutiveDo you have a knack for coordinating, organizing, and making connections? Are you ready to make a difference in the lives of others and in the comm...
- 2 Days Ago
Wound Care Sales Account Executive
- Rotech Healthcare Inc.
-
Columbia, SC
FULL_TIME
- About Rotech Rotech Healthcare Inc. is a national leader in providing ventilators, oxygen, sleep apnea treatment, wound care solutions, diabetic solutions and home medical equipment. We help patients ...
- 2 Months Ago
Restaurant Server
- Top Dawg Tavern - Columbia
-
Columbia, SC
FULL_TIME,PART_TIME
- Top Dawg Tavern is a family-owned and operated, full-service casual dining restaurant. Open 7 days a week, we offer lunch and dinner service, in a clean, family-friendly relaxed atmosphere. Founded in...
- 2 Months Ago
IT Field Technician/ATM
- Top Fortune 100 Company
-
Columbia, SC
CONTRACTOR,FULL_TIME
- Job Title: Field Service TechnicianLocation: Columbia, SC 29201 United StatesDuration: 3 Months (Temp to Per)Pay Rate: $18.50/hr.Shift Timings: Mon - Fri 08:30 am - 05:00 pmQualifications:Proposed wor...
- 2 Months Ago
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0 Top Managed Care Executive jobs found in Columbia, SC area
Shift Supervisor Trainee
- CVS Health
-
Columbia, SC
- Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to ever...
- 5/3/2024 12:00:00 AM
Federal Sales Director, Civilian & SLED
- Confluent
-
Columbia, SC
- With Confluent, organizations can harness the full power of continuously flowing data to innovate and win in the modern ...
- 5/3/2024 12:00:00 AM
IT Operations Technician, Network Support
- CHS Inc.
-
Columbia, SC
- CHS Inc. is a leading global agribusiness owned by farmers, ranchers and cooperatives across the United States that prov...
- 5/3/2024 12:00:00 AM
Special Events Operations Coordinator
- State of South Carolina
-
Columbia, SC
- Salary: $37,860.00 - $70,054.00 Annually Location : Richland County, SC Job Type: FTE - Full-Time Job Number: 163764 Age...
- 5/2/2024 12:00:00 AM
SS Hospice Area VP of Operations
- Amedisys, Inc.
-
West Columbia, SC
- Overview: Full-Time Days 125k - 155k Annually Responsible for the management and oversight of company resources within t...
- 5/2/2024 12:00:00 AM
Project Manager I / DOAS / PPS
- State of South Carolina
-
Columbia, SC
- Salary: $54,974.00 - $101,712.00 Annually Location : Richland County, SC Job Type: FTE - Full-Time Job Number: 164066 Ag...
- 5/1/2024 12:00:00 AM
Federal Grant Monitor - Columbia
- State of South Carolina
-
Columbia, SC
- Salary: $45,530.00 - $84,241.00 Annually Location : Richland County, SC Job Type: FTE - Full-Time Job Number: 163995 Age...
- 5/1/2024 12:00:00 AM
HUMAN RESOURCES DIRECTOR
- UHS
-
West Columbia, SC
- Responsibilities At Three Rivers Behavioral Health, a 129-bed facility located in West Columbia, SC, we never forget tha...
- 4/30/2024 12:00:00 AM
About Columbia, South Carolina
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 Top Managed Care Executive jobs
$196,108 to $347,923
Columbia, South Carolina area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
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