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Care Coordinator
1 day ago
Faithful Companion Pet Cremation, Inc Columbia, United States: Faithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exceed the expectat ...
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Care Coordinator
1 day ago
Faithful Companion Pet Cremation Service of NC Columbia, United States: Faithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exceed the expectat ...
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Care Coordinator
1 day ago
Faithful Companion Pet Cremation Service of NC Columbia, United States: Faithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exceed the expectat ...
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Managed Care Coordinator
3 weeks ago
Mindlance Columbia, United StatesJob 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 cr ...
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Care Coordinator
3 days ago
Faithful Companion Pet Cremation Service of NC Columbia, United States:Faithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exceed the expectati ...
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Care Coordinator
4 days ago
Faithful Companion Pet Cremation, Inc Columbia, SC, US, United StatesFaithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exceed the expectatio ...
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Care Coordinator
3 days ago
Faithful Companion Pet Cremation Inc Columbia, United StatesFaithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exceed the expectatio ...
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Care Coordinator
3 days ago
Faithful Companion Pet Cremation, Inc Columbia, United StatesJob Description · Faithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that our services exc ...
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Care Coordinator
3 days ago
Faithful Companion Pet Cremation Service of NC Columbia, United StatesJob Description · Description: · Faithful Companion Pet Cremation Services is seeking a dedicated Care Coordinator/Dispatcher to oversee the daily operations at our cremation facility location. The successful candidate will lead a professional and effective staff, ensuring that o ...
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Managed Care Coordinator UM II
1 hour ago
Ask Staffing Columbia, United States"All candidates must be directly contracted by ASK Consulting on their payroll and cannot be subcontracted. We are unable to provide sponsorship at this moment". · Job Title: Registered Nurse · Location: Onsite Training and Then Remote (Post this job in South Carolina only) · Dur ...
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Managed Care Coordinator
1 week ago
Mindlance Columbia, United StatesJob 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 clin ...
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Managed Care Coordinator UM II
3 days ago
LanceSoft Columbia, United StatesReviews 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 pr ...
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Coordinator, Individualized Care
2 weeks ago
Cardinal Health Columbia, United States**_What Individualized Care contributes to Cardinal Health_** · Delivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Car ...
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University of South Carolina Columbia, United StatesThe primary role of the P 4 Handle With Care/ Mental Wellness Program Coordinator (P 4 HWC/ MWPC) position is to provide follow-up support to school personnel, community agencies, families, and children identified through the HWC notification system, Program Coordinator, Wellness ...
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Regional Nurse Care Coordinator
3 weeks ago
State of South Carolina Columbia, United StatesJob Responsibilities · Do you have a passion to provide meaningful contributions to your community? Would you like to be part of an organization whose central mission is helping to protect, stabilize and strengthen the lives of South Carolina's children, families, and vulnerable ...
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Managed Care Coordinator UM II
4 weeks ago
LanceSoft Columbia, United StatesReviews 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 pr ...
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Coordinator, Managed Care II/CM-DM
3 weeks ago
Mindlance Columbia, United StatesDuties: · 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 ...
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Coordinator, Managed Care II/CM-DM
3 weeks ago
LanceSoft Columbia, United StatesReviews 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 p ...
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Coordinator, Managed Care II/CM-DM
4 weeks ago
LanceSoft Columbia, United StatesReviews 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 p ...
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PRN Registered Nurse
2 weeks ago
Addus Homecare Columbia, United StatesTo text to apply, text 5749 to · Position Summary · : · The PRN RN will be responsible for delivering professional nursing care to patients, by supporting and providing initial and ongoing patient assessments in accordance with the established plan of care, attending physicians' ...
Managed Care Coordinator I - Columbia, United States - LanceSoft
Description
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.10% 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.
