Top Managed Care Executive jobs in South Carolina
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
- LanceSoft, Inc.
-
Columbia, SC
CONTRACTOR
-
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.
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. 1
0% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
Required Skills and Abilities:
Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Knowledge of contract language and application. Thorough knowledge/understanding of claims/coding analysis/requirements/processes.
Preferred Software and Other Tools: Working knowledge of Microsoft Excel, Access or other spreadsheet/database software. Work Environment: Typical office environment. Employee may work from one's/out of one's home. May involve some travel within one's community. - 5 Days Ago
Telephonic Medical Case Manager (Workers' compensation)
- TRISTAR MANAGED CARE INC
-
Summerville, SC
FULL_TIME
- Please make sure that you complete all of the questions and navigate to the end of the application to sign the application. This will be a remote position. Preferred experience in New York, New Jersey...
- Just Posted
Lawn Care Tech Trainee
- Top Turf Inc
-
Greer, SC
FULL_TIME
- Top Turf is the Southeast's leading independently owned lawn care and pest control company. We have been around for over twenty years because we create lawns that you have always dreamed of. Our longe...
- 29 Days 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 ...
- 1 Day Ago
Coordinator, Managed Care II/CM-DM
- LanceSoft, Inc.
-
Columbia, SC
CONTRACTOR
- Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service r...
- 3 Days Ago
Managed Care Coordinator II/CM-DM
- SPECTRAFORCE
-
Columbia, SC
CONTRACTOR
- Job Title: Managed Care Coordinator IILocation: Columbia, SC. 29219 (Remote after 1 week onsite training. Have to come in periodically for meetings/classes as needed)Duration: 3 months assignment with...
- 6 Days Ago
Top Managed Care Executive jobs at Popular Companies
Director OF Clinical Services (Center-Based)
- Centria Autism
-
Phoenix, AZ
- Centria Autism is the largest provider of Applied Behavior Analysis (ABA) for children with Autism Spectrum Disorder (AS...
- 6/12/2024 12:00:00 AM
Accreditation Specialist (Clinical)
- Sanford Health
-
Fargo, ND
- Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the Unite...
- 6/12/2024 12:00:00 AM
Health Systems Engineer
- Sanford Health
-
Sioux Falls, SD
- Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the Unite...
- 6/12/2024 12:00:00 AM
Health Systems Engineer
- Sanford Health
-
Fargo, ND
- Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the Unite...
- 6/12/2024 12:00:00 AM
Chief Operating & Experience Officer, Health Plan
- Sanford Health
-
Sioux Falls, SD
- Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the Unite...
- 6/12/2024 12:00:00 AM
Director, Denial Management & Prevention - Relocation Offered!
- MEDSTAR HEALTH
-
Baltimore, MD
- General Summary of Position The Director, Denial Management & Prevention is responsible for directing and administering ...
- 6/12/2024 12:00:00 AM
Assistant Manager of Nursing Medical Surgical - Relocation Offered!
- MEDSTAR HEALTH
-
Clinton, MD
- General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nur...
- 6/12/2024 12:00:00 AM
Assistant Manager of Nursing Float Pool - Relocation Offered!
- MEDSTAR HEALTH
-
Clinton, MD
- General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nur...
- 6/12/2024 12:00:00 AM
About South Carolina
South Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the Southeastern United States and the easternmost of the Deep South. It is bordered to the north by North Carolina, to the southeast by the Atlantic Ocean, and to the southwest by Georgia across the Savannah River.
South Carolina became the eighth state to ratify the U.S. Constitution on May 23, 1788. South Carolina became the first state to vote in favor of secession from the Union on December 20, 1860. After the American Civil War, it was readmitted into the United States on June 25, 1868.
South Carolina is the 40th most extensive and 23...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Managed Care Executive jobs
$200,158 to $355,110
Most Popular Cities in South Carolina for Top Managed Care Executive Jobs
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