Resolves managed care operational issues such as authorization for services, billing, and claims payment. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Maintains managed care contracts and educational information databases. May require an associate's degree and certification as a registered nurse with 2-4 years of experience in the field or in a related area. Familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. A certain degree of creativity and latitude is required. Works under general supervision. Typically reports to a supervisor or manager.
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