Medical Policy Manager jobs in Columbia, SC

Medical Policy Manager manages and implements corporate policy and process for medical provider and other reimbursements. Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Being a Medical Policy Manager evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost. Requires a bachelor's degree of finance, business or healthcare administration. Additionally, Medical Policy Manager typically reports to head of a unit/department. The Medical Policy Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Policy Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Medical Case Manager
  • Sandhills Medical Foundation
  • Lugoff, SC FULL_TIME
  • Medical Case Manager


    Position Overview:

    Under the general direction of the Ryan White Program Director, the Medical Case manager will provide direct services to HIV patients and their families. In addition, the medical case manager is part of a Patient-Centered Medical Home (PCMH) team and is expected to be familiar with the philosophy, goals, and objectives of the PCMH.


    Knowledge/Skill Requirements:

    • A Bachelor's degree in nursing, social work, public/business administration, or health related field; or, any combination of education, training, and experience demonstrating the ability to perform the position’s duties.
    • Knowledge of HIV/AIDS population, barriers to care, disease prevention and transmission, and sensitivity to the social stigma that exists for persons living with HIV are helpful.
    • Excellent organizational skills.
    • Able to work independently and manage multiple priorities.
    • Ability to meet deadlines.
    • Skilled in verbal and written communication.
    • Experience working with people of various ethnic backgrounds, low incomes, and in rural areas.


    Job Duties:

    • Conducts a complete assessment of the patient’s health, mental health, financial situation, housing situation, legal, social, educational, employment status, etc., and designs a care plan based on the assessment.
    • Develop and carry out a treatment plan with each patient, advocates for the patient, and make referrals to other providers as needed.
    • Recruit patients or people for PreP.
    • Assists patients in obtaining needed benefits such as Medicaid, Disability, Food Stamps, or other health insurance.
    • Provides medical and medication adherence counseling.
    • Helps patients obtain medication through the statewide ADAP and other drug assistance programs.
    • Completes social services applications for patients as appropriate.
    • Makes referrals based on patient needs for mental health counseling, substance abuse counseling, housing or financial issues, Community Long Term Care (CLTC), etc.
    • Stays current on HIV/AIDS-related research and health information and maintains strong relationships with outside organizations.
    • Integrates information into patients' electronic medical records as appropriate.
    • Completes progress logs and other CAREWARE documentation in a timely manner.
    • Documents use of time using agency-approved forms and guidelines.
    • Identifies and recruits patients from caseload to participate in committees, workshops, community initiatives, etc.
    • Function as a member of the Clinical Care and Quality Team with the client's primary medical care provider, pharmacist, behavioral health, and other providers.
    • Participates in National HIV/AIDS observances.
    • Serve as a representative at professional meetings.
    • Ability and willingness to work flexible hours, including evenings and weekends, as required.
    • Maintains confidentiality and privacy in accordance with HIPPA and SMF.
    • Always exhibits professional conduct.


    Supervisory Duties: None


    Training:

    • The Medical Case Manager will be responsible for attending all mandatory training including evidence-based approaches to self-management support, proactively addressing the needs of patients and families in this community, cultural competency, effective communication, care coordination, OSHA, HIPPA, EMR, HIV/AIDS, etc.


    Additional Requirements:

    • Must be willing to work with SMF EMR system.
    • Must have a valid driver’s license to drive and/or availability of personal vehicle with automobile insurance.
    • Must be willing to work at different SMF locations when requested.
    • Able to show flexibility when policies change or with client requests.
    • Ability to utilize a personal computer.
    • Knowledge of community resources.


    Other Duties as Assigned


    Physical Demands and Work Environment:

    • Ability to sit and/or stand for long periods of time.
    • Constantly operate a computer and other office productivity machinery such as a: calculator, copy machine, and computer printer.
    • Computer literate in a PC environment, including the ability to enter and access data from accounting and billing systems.
    • Ability to physically write and visually read.


    Disclaimer:

    Nothing on this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This job description doesn't constitute a contract of employment, and the company may exercise its employment-at-will rights at any time. SMF is an Equal Employment Opportunity Employer.


    **Sandhills Medical Foundation, Inc. does not discriminate on the basis of race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors.


    Bilingual is a Plus


    Sandhills Medical Foundation, Inc. has been providing quality, comprehensive health care since 1977. We are a Federally Qualified Health Center (FQHC) serving residents of Chesterfield, Kershaw, Lancaster, and Sumter counties. The mission of Sandhills Medical Foundation, Inc. is to be responsive to community healthcare needs by providing quality, comprehensive, and cost effective healthcare.
    • 401k
    • 401k matching
    • Health Insurance
    • Dental Insurance
    • Life Insurance
    • Vision Insurance
    • PTO and Sick Leave
    • Employee EAP Program
  • 7 Days Ago

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SS Medical (DME) Durable Medical Equipment Assistant Branch Manager
  • SS Medical
  • Columbia, SC FULL_TIME
  • SS Medical is solely a Durable Medical Equipment (DME)/Home Medical Equipment (HME) VA contractor. SS Medical is looking for a new Assistant Manager. We are searching for someone with experience deliv...
  • 3 Days Ago

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Public Health Analyst (Policy)
  • Centers for Disease Control and Prevention
  • Columbia, SC FULL_TIME
  • As a global leader in public health & health promotion, CDC is the agency Americans trust with their lives. In addition to our everyday work, each CDC employee has a role in supporting public health e...
  • 9 Days Ago

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Policy Analysis Program Specialist
  • Administration for Children and Families
  • Columbia, SC FULL_TIME
  • This position is located in the Department of Health and Human Services, Administration for Children and Families, Office of Refugee Resettlement (ORR), UC Policy/Policy Coordination Team, located in ...
  • 12 Days Ago

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Medical Case Manager- HIV, Infectious Disease, FT, Days
  • 270 Prisma Health Medical Group-Midlands
  • Columbia, SC FULL_TIME
  • Inspire health. Serve with compassion. Be the difference. Job Summary Provides outpatient HIV medical case management services and patient advocacy through education, counseling, advocacy, benefits as...
  • 19 Days Ago

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Care Manager
  • Lexington Medical Center
  • West Columbia, SC FULL_TIME
  • Step Down ICU Full Time Day Shift 7a-3p Sign-On Bonus: 20,000 Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of it...
  • 17 Days Ago

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0 Medical Policy Manager jobs found in Columbia, SC area

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Remote Licensed Mental Health Counselor
  • Headway
  • Columbia, SC
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Counselo...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Clinical Social Worker
  • Headway
  • Columbia, SC
  • Remote Licensed Clinical Social Worker (LCSW) Wage: Between $120-$131 an hour Are you a Licensed Clinical Social Worker ...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Columbia, SC
  • Remote Licensed Psychiatrist Wage: Between $232 - $269 an hour Are you a licensed Psychiatrist looking to launch a priva...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Clinical Psychologist
  • Headway
  • Columbia, SC
  • Remote Licensed Clinical Psychologist Wage: Between $166-$196 an hour Are you a Licensed Clinical Psychologist looking t...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Mental Health Therapist
  • Headway
  • Columbia, SC
  • Remote Licensed Mental Health Therapist (LMHT) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Therapis...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practioner
  • Headway
  • Columbia, SC
  • Remote Licensed Psychiatric Nurse Practitioner Wage: Between $203 - $269 an hour Are you a licensed Psychiatric Nurse lo...
  • 3/28/2024 12:00:00 AM

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Psychologist (PhD, PsyD) - Clinical Therapy - Outpatient
  • LifeStance Health
  • Columbia, SC
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 3/28/2024 12:00:00 AM

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Remote Licensed Mental Health Counselor
  • Headway
  • Columbia, SC
  • Remote Licensed Mental Health Counselor (LMHC) Wage: Between $120-$131 an hour Are you a Licensed Mental Health Counselo...
  • 3/27/2024 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 Medical Policy Manager jobs
$120,986 to $147,704
Columbia, South Carolina area prices
were up 1.5% from a year ago

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