Managed Care Coordinator
US Tech SolutionsColumbia, SC, United States16 days ago
Job type
- Temporary
Job descriptionReviews 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, claims knowledge / analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, 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. Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions thatconsist 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. Performs medical or behavioral review / authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. 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 isnot 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. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and / or health and disease management programs. 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. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. 4 years recent clinical in defined specialty area. Specialty areas include : oncology, cardiology, neonatology, maternity, rehabilitation services, mental health / chemical dependency, orthopedic, general medicine / surgery. Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. 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.. Associate Degree - Nursing.
Location : Columbia, SC 29219 (Remote after training)
Duration : 3+ Months Contract (Possible Extension)
Job Description :
- Must be an RN in SC and have an active and unrestricted SC RN license.
- Hours / Schedule - Monday-Friday, 8 : 30am-5pm, two late shifts per month - 11 : 30am-8pm.
- Will be required to complete at least 1 week of training onsite.
- A typical day would like in this role : Employee will be providing telephonic case management and utilization management for our members. The expectation is to manage a caseload of 50 to 60 members per month.
- Strong communication skills required to provide telephonic case management to patients and to coordinate with team, providers, and patient representatives regarding patient care.
- Skill sets / qualities : Looking for someone with excellent telephonic communication skills and strong computer literacy skills.
Responsibilities :
Experience :
Skills :
Education :
About US Tech Solutions :
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Recruiter Details : Name : Shailesh
Email : shailesh.c@ustechsolutionsinc.com
Internal Id : 25-50171
Create a job alert for this search
Managed Care Coordinator • Columbia, SC, United States
Related jobs
Supports FMCNA’s mission, vision, core values and customer service philosophy.Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.Ensure&nb...Show moreLast updated: 30+ days ago
Become a part of our caring community and help us put health first.This is a full time position, scheduled 40 hours a week.
Scheduled 4 days a week from Friday-Monday working 10 hour shifts from 8am...Show moreLast updated: 13 hours ago
Performs a variety of administrative, secretarial and clerical tasks involved in the operation of the department.Coordinates activities of the office.
Works to ensure resolution of issues while main...Show moreLast updated: 13 days ago
Interim HealthCare Inc is seeking a Home Health Physical Therapist for a job in Elloree, South Carolina.Job Description & Requirements.
Discover a new lane in therapy where treatments are person...Show moreLast updated: 30+ days ago
Discover a new lane in therapy where treatments are personal and outcomes are optimal.As a Home Health Physical Therapist, you’ll help patients regain their strength, manage their pain and re...Show moreLast updated: 1 day ago Prepares financial and reimbursement analyses, conducts research and analyzes trends to optimize coding and reimbursement, and leads education for all facets of the revenue cycle.Assists with the d...Show moreLast updated: 30+ days ago 
We are seeking a proactive, compassionate, and detail-oriented.This role is pivotal in ensuring the successful planning and implementation of our educational programs, mentoring staff, and maintain...Show moreLast updated: 30+ days ago
Role Name : Managed Care Coordinator UM II.Work Environment : (Remote after 4-6 weeks of Onsite training).Contract length : 3 months assignment with possible conversion.
Reviews and evaluates medical o...Show moreLast updated: 30+ days ago
Role Name : Managed Care Coordinator I (Part-time).Work Environment : (Remote after 1-2 weeks of Onsite training).Hours Per Week, 8 Hours Per Day.
Contract length : 4 months assignment with possible co...Show moreLast updated: 18 days ago
Department of Behavioral Health and Developmental Disabilities.Greater Bryan Psychiatric Hospital.Agency Specific Application Procedures : : .
Please complete the state application to include all curre...Show moreLast updated: 9 hours ago
Coordinator, Revenue Cycle Management.Practice Operations Management oversees the business and administrative operations of a medical practice.
Revenue Cycle Management manages a team focused on a s...Show moreLast updated: 16 days ago
From the Upstate to the Lowcountry, the University of South Carolina system is transforming the lives of South Carolinians through the impact of our eight institutions and 20 locations throughout t...Show moreLast updated: 30+ days ago
RELOCATE TO VIRGINIA OPPORTUNITY.Join our esteemed team of healthcare professionals committed to advancing healthcare through cutting-edge research, comprehensive training, and compassionate care.U...Show moreLast updated: 11 hours ago
Ally Psychiatry is a dynamic growth company in the behavioral healthcare space currently scaling from a small business to a middle-market company.
The organization is experiencing rapid expansion an...Show moreLast updated: 12 hours ago UM Administration Coordinator 2.Become a part of our caring community and help us put health first.The UM Administration Coordinator 2 contributes to administration of utilization management.The UM...Show moreLast updated: 12 hours ago Responsible for the implementation, management and oversight of clinical trial research studies including the education of research staff, healthcare team member, participants and their caregivers....Show moreLast updated: 30+ days ago 
At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better.
Our mission is to help people lead healthier, more fulfilling lives...Show moreLast updated: 11 hours ago Role Name : Managed Care Coordinator II / CM-DM (Social Worker).Work Environment : Remote (after 1 week onsite).Schedule : Mon-Fri, 8 : 30 am to 5 : 00 pm.
Contract length : 3-month assignment with possible ...Show moreLast updated: 5 days ago
- Promoted
Clinical Coordinator - Charge Registered Nurse - Dialysis
Fresenius Medical CareColumbia, SC, USFull-time
- Promoted
- New!
Home Health Intake Coordinator
CenterWellColumbia, SC, United StatesFull-time
- Promoted
Office Coordinator, Surgery, FT, Days
Prisma HealthColumbia, SC, United StatesFull-time
- Promoted
Home Health Physical Therapist
Interim HealthCare IncElloree, SC, USFull-time +1
- Promoted
Physical Therapist Home Health ($10k Sign-on Bonus!)
Interim HealthCareSaint Matthews, SC, USFull-time +1
- Promoted
Periop Revenue Charge Coordinator, PT Days
Prisma HealthColumbia, SC, United StatesFull-time
- Promoted
Program Coordinator
Kiddie Academy of Columbia, SCColumbia, SC, USFull-time
- Promoted
Managed Care Coordinator UM II
Spectraforce TechnologiesColumbia, SC, United StatesFull-time
- Promoted
Managed Care CoordinatorI (Part-time)
Spectraforce TechnologiesColumbia, SC, United StatesPart-time
- Promoted
- New!
Administrative Coordinator I
State of South CarolinaCayce, SC, United StatesFull-time
- Promoted
Coordinator, Revenue Cycle Management
South Carolina StaffingColumbia, SC, USFull-time
- Promoted
Administrative Coordinator
InsideHigherEdColumbia, South Carolina, United StatesFull-time
- Promoted
- New!
Complex Care Coordinator (RN) - Pediatric Dialysis
UVA HealthColumbia, SC, USFull-time +1
- Promoted
- New!
Patient Care Coordinator
ALLY Psychiatry Career PageCamden, SC, USFull-time
- Promoted
- New!
UM Administration Coordinator
South Carolina StaffingColumbia, SC, USFull-time
- Promoted
Research Coordinator II, Cardiology, Full Time, Days
Prisma HealthColumbia, SC, United StatesFull-time +1
- Promoted
- New!
Marriage and Family Therapist (LMFT)
LifeStance HealthPelion, SC, USFull-time
- Promoted
Managed CareCoordinator II / CM-DM
Spectraforce TechnologiesColumbia, SC, United StatesFull-time