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)
JOB SUMMARY
The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers as well as assist in the preparation for changes in the healthcare industry.
The Consultant will negotiate managed care payer contract rates and terms and provide guidance with regards to the development of managed care relationships, ensuring timeliness and appropriateness of negotiated rates.
Additionally, the Resource will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services and help with contract cancellations, denials, appeals and high level contract payment disputes.
DUTIES & RESPONSIBILITIES
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)
Please note this job description has been designed to indicate the general nature, working conditions and level of work performed by employees within this job.
It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, working conditions and qualifications required of employees assigned to this job.
Duties, responsibilities and activities may change at any time with or without notice. Additionally, the incumbent may be requested to perform job-related tasks other than those stated in this description.
Last updated : 2024-03-09