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Job Title: Managed Care Coordinator
Job Location: Columbia, SC
Top 3/5 Skills:
· RN / Registered Nurse License
· Chronic condition care
· Case Management
Job Responsibilities
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, 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. these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.
Managed Care Coordinator
Job Requirements
· Associate Degree - Nursing, OR, Graduate of Accredited School of Nursing, OR, Master's degree in Social Work (for Div. 6B or Div. 75) or Master's in Psychology, or Counseling.
· Required Experience: Recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years’ utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
· Required License/Certificate: An active, unrestricted RN license 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)
Full Time
$66k-97k (estimate)
05/18/2024
06/03/2024
mindlance.com
KING OF PRUSSIA, PA
1,000 - 3,000
1999
Private
$50M - $200M
Business Services
Mindlance is a provider of technical staffing, product engineering and direct sourcing solutions for enterprises.
The following is the career advancement route for Managed Care Coordinator positions, which can be used as a reference in future career path planning. As a Managed Care Coordinator, it can be promoted into senior positions as a Managed Care Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Managed Care Coordinator. You can explore the career advancement for a Managed Care Coordinator below and select your interested title to get hiring information.