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)

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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 Education: Associate Degree - Nursing or Graduate of Accredited School of Nursing or Master's degree in Social Work, Psychology, or Counseling.
    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.

     

  • 19 Days Ago

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Managed Care Coordinator (31301558)
  • Professional Management Enterprises
  • Columbia, SC FULL_TIME
  • Seeking anRNwithManaged Care and Utilization Managementexperience to review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria. This position is remote, but requir...
  • Just Posted

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Manager Managed Care
  • Roper St. Francis Healthcare
  • Ladson, SC FULL_TIME
  • Job Summary: Responsible for managed care initiatives & performance, including contracting, reporting, and operations, related to hospitals, physicians (employed and contracted), Home Health, Hospice,...
  • 16 Days Ago

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Managed Care Coordinator II
  • Spectraforce Technologies
  • Columbia, SC FULL_TIME
  • Job Title: Managed Care Coordinator II Location: Columbia, SC 29219 (at least 1 week of onsite training then remote) Duration: 3 months assignment with possible extensions Shift: Mon -Fri, 8:30 am to ...
  • 1 Month Ago

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1099 Sales Executive (Medical Device)
  • Top Tier Reps LLC
  • Charleston, SC FULL_TIME
  • Salary: Commission-based with a performance bonusMedical device sales representatives are responsible for selling medical equipment to hospitals, health systems, doctor's offices, and clinics, Respons...
  • 17 Days Ago

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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...
  • 10 Days Ago

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Account Manager (Entry Level)
  • Barton Careers
  • Worcester, MA
  • Overview Work hard and grow fast with Barton Associates! For this entry-level position, we’re seeking competitive, caree...
  • 3/28/2024 12:00:00 AM

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Account Manager (Entry-Level)
  • Barton Careers
  • Keene, NH
  • Overview Work hard and grow fast with Barton Associates! For this entry-level position, we’re seeking competitive, caree...
  • 3/28/2024 12:00:00 AM

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Territory Sales Manager – Dairy Feed
  • Blue Signal Search
  • Amarillo, TX
  • Our client is a major player in the dairy feed nutrition industry. They are hiring a Territory Sales Manager knowledgeab...
  • 3/28/2024 12:00:00 AM

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Product Marketing Manager
  • Yooz
  • Coppell, TX
  • If you’re intrigued by innovation, love the art of delivering excellence to customers, and are inspired by a work hard /...
  • 3/28/2024 12:00:00 AM

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Senior Manager, Application Development
  • Universal Orlando
  • Orlando, FL
  • Universal Orlando Resort believes in-person collaboration is key to our success. Many of our Team Members work in a hybr...
  • 3/28/2024 12:00:00 AM

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Territory Sales Manager – Dairy Feed
  • Blue Signal Search
  • Lubbock, TX
  • Our client is a major player in the dairy feed nutrition industry. They are hiring a Territory Sales Manager knowledgeab...
  • 3/28/2024 12:00:00 AM

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Territory Sales Manager – Dairy Feed
  • Blue Signal Search
  • Clovis, NM
  • Our client is a major player in the dairy feed nutrition industry. They are hiring a Territory Sales Manager knowledgeab...
  • 3/28/2024 12:00:00 AM

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Harvest Interns
  • Patz & Hall Wine Company
  • Sonoma, CA
  • If you are a hard-working person who places a high standard upon craftsmanship, please read on. Patz & Hall Winery is ex...
  • 3/28/2024 12:00:00 AM

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
$198,837 to $352,765

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