Managed Care Provider Relations Manager jobs in South Carolina

Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Telephonic Medical Case Manager (Workers' compensation)
  • TRISTAR MANAGED CARE INC
  • Summerville, SC FULL_TIME
  • Please make sure that you complete all of the questions and navigate to the end of the application to sign the application.


    This will be a remote
    position. Preferred experience in New York, New Jersey, and Pennsylvania. The primary role is for New York files. Must have unrestricted nursing license.

    POSITION SUMMARY: The medical case manager provides telephonic case management in a workers’ compensation environment coordinating resources and cost effective options on a case-by case basis to facilitate quality individualized treatment goals and return to work placement.

    ESSENTIAL DUTIES AND RESPONSIBILITIES: Possess excellent communication and organizational skills to interface with the client, claimants and staff. Work well independently and set priorities.

    Primary responsibilities include:

    • Provide telephonic outreach for assessment, and follow up for case communication and coordination to include assessing, planning, implementing, coordinating of care
    • Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan
    • Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner
    • Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services
    • Assessment of medical records for appropriateness of treatment and level of care being provided. Referral to the Medical Director if appropriate within the established timeframes
    • Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians
    • Maintains contact and communicates updated activity with all parties involved with the case
    • Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes. Negotiate treatment plan with treating physician


    Additional Functions and Responsibilities

    • Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
    • Maintain minimum billing and established template documentation standards adhering to URAC standards and company policy and procedures
    • Reporting billing hours in accordance with case activity and billing practices
    • Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
    • Other job duties as assigned

    Education:

    • Diploma, Associate or Bachelor’s degree in Nursing, Master’s level (or higher) in a Nursing, Health or Human Services field or equivalent related experience preferred
    • Current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN) and or Certified Case Manager (CCM) license required
    • CCM, CMCN, CPHUR, CPDM, COHN or CDMS certification preferred


    Experience
    :

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

    • Three or more years of diverse clinical experience in acute care
    • Two or more years of medical case management or managed care experience, Worker’s Compensation background preferred
    • Knowledge of utilization management, quality improvement, discharge planning, and or cost management.
    • Ability to solve practical problems and deal with a variety of variables.
    • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
    • Excellent interpersonal skills and excellent organizational skills.
    • Ability to set priorities and work independently is essential
    • Proficient with Microsoft Office applications including Word, Excel, and Power Point


    SPECIAL EQUIPMENT OR CLOTHING:

    Professional attire adhering to the Company Dress Code


    Here are some of the benefits you can enjoy in this role:

    • Medical, Dental, Vision, Disability & Life Insurance
    • 401(k) plan
    • Paid time off
    • Paid holidays


    MENTAL AND PHYSICAL REQUIREMENTS


    • MENTAL EFFORT

    • Reasoning development:


    Follow one- or two-step instructions; routine, repetitive task.


    Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.


    Follow written, verbal, or diagrammatic instructions; several concrete variables.


    X Solve practical problems; variety of variables with limited standardization; interpret instructions.


    Logical or scientific thinking to solve problems; several abstract and concrete variables.


    Wide range of intellectual and practical problems; comprehend most obscure concepts.


    • Mathematical development:


    Simple additional and subtraction; copying figures, counting, and recording.


    Add, subtract, multiply, and divide whole numbers.


    X Arithmetic calculations involving fractions, decimals, and percentages.


    Arithmetic, algebraic, and geometric calculations.


    Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.


    Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.


    • Language development:


    Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.


    Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.


    Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.


    X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.


    Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.


    • PHYSICAL EFFORT

    • Physical activity required to perform the job:


    Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.


    X Light work:

    • Exerting up to 20 pounds of force occasionally
    • Exerting up to 10 pounds frequently
    • Exerting a negligible amount of force constantly to move objects


    (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).


    Medium work:

    • Exerting up to 50 pounds of force occasionally
    • Exerting up to 20 pounds of force frequently
    • Exerting up to 10 pounds of force constantly to move objects


    Heavy work:

    • Exerting up to 100 pounds of force occasionally
    • Exerting up to 50 pounds of force frequently
    • Exerting up to 20 pounds of force constantly to move objects


    Very heavy work:

    • Exerting in excess of 100 pounds of force occasionally
    • Exerting in excess of 50 pounds of force constantly to move objects
    • Exerting in excess of 20 pounds of force constantly to move objects



    • Visual requirements necessary to perform the job:


    Far vision: clarity of vision at 20 feet or more


    X Near vision: clarity of vision at 20 inches or less


    X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet


    Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are


    Color vision: ability to identify and distinguish colors


    Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point


    • PHYSICAL EFFORT
      (cont.)


    FREQUENCY


    • Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):


    Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.


    Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.


    Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.


    Kneeling: Bending legs at knee to come to a rest on knee or knees.


    Crouching: Bending the body downward and forward by bending legs and spine.


    Crawling: Moving about on hands and knees or hands and feet.


    Reaching: Extending hand(s) and arm(s) in any direction.


    Standing: Particularly for sustained periods of time.


    Walking: Moving about on foot to accomplish tasks, particularly for long distances.


    Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.


    Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.


    Foot

    Motion: Using feet to push pedals.


    Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.


    X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.


    X Grasping: Applying pressure to an object with the fingers and palm.


    Frequently


    Occasionally


    EQUIPMENT OPERATED/USED:

    Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System Applications

    Essential Tools: Pens, pencil, computer, Keyboard

    Essential Vehicles: N/A


    SPECIAL EQUIPMENT OR CLOTHING:

    Professional attire adhering to the Company Dress Code

  • Just Posted

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Managed Care Coordinator I
  • LanceSoft, Inc.
  • Columbia, SC CONTRACTOR
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  • 5 Days Ago

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Managed Care Licensing and Credentialing Liaison
  • Medical Services of America
  • Lexington, SC FULL_TIME
  • Our Credentialing Support Specialist will be responsible to complete, submit and track credentialing data while demonstrating high attention to detail and accuracy with emphasis on timeliness. We are ...
  • 1 Day Ago

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In Home Care Provider
  • Trusted Home Care
  • Little River, SC PART_TIME,FULL_TIME
  • We are looking for Compassionate, Hardworking, Reliable, and Dependable caregivers to help in daily living and personal care services in patients homes in accordance with an established care plan. We ...
  • 18 Days Ago

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In Home Care Provider
  • Trusted Home Care
  • Conway, SC FULL_TIME
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  • 25 Days Ago

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Quality Assurance Manager
  • Provider Resources, Inc.
  • Dillon, SC FULL_TIME
  • Position Description: Quality Assurance Manager Under the direction of the Program Manager for the Independent Dispute Resolution Entity (IDRE) or their delegate, the Quality Assurance Training Manage...
  • 21 Days Ago

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Relationship Manager
  • Ascensus
  • Greensboro, NC
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  • 6/11/2024 12:00:00 AM

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Relationship Manager
  • GROVER GAMING
  • Elyria, OH
  • Job Description Job Description Job Title: Relationship Manager Department: Ohio Sales Reports To: Sales Manager Status:...
  • 6/11/2024 12:00:00 AM

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Relationship Manager
  • Allium Financial Advisors, LLC
  • Lake Oswego, OR
  • Summary This position is responsible for partnering with Financial Advisors to help manage client relationships by perfo...
  • 6/10/2024 12:00:00 AM

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Relationship Manager
  • Flourish
  • New York, NY
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  • 6/9/2024 12:00:00 AM

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Relationship Manager
  • Wind River Payments
  • Madison, WI
  • As a Relationship Manager at Wind River Payments (WRP), you will thrive on building strong, long-term client relationshi...
  • 6/9/2024 12:00:00 AM

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Relationship Manager
  • Palmetto
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  • 6/7/2024 12:00:00 AM

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Relationship Manager
  • Valley Bank
  • Jacksonville, FL
  • Why you should consider applying to this opportunity: You're excited to build relationships with Commercial & Industrial...
  • 6/7/2024 12:00:00 AM

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Relationship Manager
  • Team Select Home Care
  • Evansville, IN
  • Overview: You can apply by texting TSC to 97211 Now offering DailyPay! Ask us about it! Are you looking for an exciting ...
  • 6/7/2024 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 Managed Care Provider Relations Manager jobs
$95,676 to $138,016

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