Managed Care Supervisor supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Being a Managed Care Supervisor experienced in utilization review techniques and protocols. Requires a bachelor's degree. Additionally, Managed Care Supervisor typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. The Managed Care Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. To be a Managed Care Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. (Copyright 2024 Salary.com)
This position works in collaboration with the Vice President of Contracting and Senior Director of Payor Relations to assist with all aspects of managed care operations including contract negotiation, contract payment modeling, and contract implementation. This position acts as a liaison between Payor Relations and other internal and external entities to create seamless operational managed care performance along with maximizing payor contracting terms. The individual will be responsible for high-level, sophisticated reporting, modeling, and analyses using both hospital and professional claims data. This employee adeptly collaborates with management, operations, and administrative support teams to efficiently undertake the necessary steps crucial for successful contract negotiations. This position will make sure that negotiations are handled efficiently to meet important deadlines and remain within approved financial parameters.