Managed Care Coordinator jobs in Pennsylvania

Managed Care Coordinator coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Being a Managed Care Coordinator communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Additionally, Managed Care Coordinator typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). The Managed Care Coordinator has gained full proficiency in a broad range of activities related to the job. Independently performs a wide range of complex duties under general guidance from supervisors. To be a Managed Care Coordinator typically requires 5-7 years of related experience. (Copyright 2024 Salary.com)

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MOMobile Managed Care Program Manager
  • Maternity Care Coalition
  • Philadelphia, PA FULL_TIME
  • Organizational Summary

    In 1980, a group of Philadelphia health and social justice activists came together over concerns about the well-being of pregnant people and infants. They created Maternity Care Coalition (MCC) and advocated for change with policymakers and decision makers.


    Today, we continue to center children and their families by supporting, referring, educating, researching, and advocating.


    Position Summary
    Responsible for day-to-day operations of the MOMobile Managed Care program. Provides leadership in conducting outreach, follow-up, and home visiting to identify pregnant women and families with young children and provide appropriate services.

    Benefits include:
    • Three (3) weeks paid vacation, plus One (1) week paid Winter Break
    • Medical, Dental, Vision, Voluntary & Supplemental Life Insurance through CIGNA
    • Cafeteria Plan through Benefit Wallet: FSA and Commuter plans

    Essential Functions

    • Manages and monitors all MOMobile Managed Care activities and ensures quality of services.
    • Provides supervision to managed care advocates and student intern(s).
    • Responsible for recruitment and hiring of managed care advocates.
    • Acts as a community liaison between MCC, clients, and Medicaid managed care organizations (MCOs) and manages referrals from MCO partners.
    • Routinely communicates with MCO providers and schedules monthly/bi-monthly check-in meetings.
    • Oversees the contract scope of services with MCO partners.
    • Prepares and submits all reports and invoices as required by funders.
    • Develops and monitors program budgets and spending.
    • Communicates and coordinates contract requirements with other MCC program managers.
    • Facilitates regular staff meetings and conducts individual supervisory meetings.
    • Conducts regular home visit observations.
    • Provides direct services to a small caseload when needed.
    • Regularly reviews client files and provides feedback to staff.
    • Prepares performance evaluations with input from staff.
    • Identifies staff training needs and writes yearly training plans.
    • May be required to travel the eight-county region

    Other Tasks

    • Adheres to the MCC’s security guidelines and ensures the appropriate handling of sensitive information.
    • Attends relevant staff meetings to promote communication and execution of goals.
    • Completes special projects specific to the function of the department or as needed for the department as directed by the supervisor.
    • Other duties as assigned within the scope of position expectations.

    Knowledge, Skills, and Abilities

    • Understanding of MCC’s mission, goals, and objectives and ability to work independently with a high level of energy and contribute as part of a larger team.
    • Knowledge of the concepts and practices associated with community health issues, particularly with pregnant women, prenatal care, parenting and other services for mothers, young children, and their families.
    • Ability to travel in and around the Greater Philadelphia region to conduct home visits and community outreach.
    • Knowledge of and sensitivity to issues facing the community served.
    • Experience in client management procedures for determining eligibility, assessing needs, identifying resources, making referrals, following up, and documenting client interactions.
    • Demonstrated clinical social work skills.
    • Strong interpersonal skills as demonstrated by compassionate, courteous, cordial, cooperative, and professional interaction with diverse groups of co-workers, community partners, clients, and members of the community.
    • Ability to operate a computer and use a variety of common software programs including Microsoft Office, spreadsheets, and customized databases.
    • Effective and accurate documentation of case notes and client data according to established client management documentation procedures.
    • Ability to organize tasks in an efficient manner and follow-up and follow-through with strong attention to detail.
    • Proficient with Microsoft Office Suite, ability to operate a computer and use a variety of common software programs a must
    • Experience utilizing virtual meeting platforms
    • This is a telecommuting position. Staff are required to be onsite at least (1) day a week (you can add your requirement). In addition, staff must establish a safe and supportive workspace at home.

    Experience, Education, and Licensure

    • Master’s degree in social work or related field strongly preferred; bachelor’s degree required.
    • 2 years of supervisory experience preferred
    • Valid driver’s license
  • 18 Days Ago

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Managed Care Support Analyst
  • Allegheny Health Network
  • Remote Position, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This role processes payor contracts for single case agreements, manages contract repository, and completes facility credentialing...
  • 27 Days Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Pittsburgh, PA FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
  • 1 Month Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Philadelphia, PA FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
  • 1 Month Ago

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Managed Care Contract Specialist
  • Allegheny Health Network
  • Remote Position, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job serves as the primary negotiator for Single Case Agreements related to non-contracted entities, while also being respons...
  • 1 Month Ago

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Coordinator, Industry Managed Programs (Temporary)
  • FULLSIGHT, LLC
  • Warrendale, PA TEMPORARY
  • SUMMARY: We are seeking a skilled and motivated person to join our dynamic team as a Coordinator, Industry Managed Programs. In this position you will contribute to the operations and management of as...
  • Just Posted

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Case Manager (Care Coordinator)
  • Pacifica Hospital of the Valley
  • Los Angeles, CA
  • Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
  • 4/25/2024 12:00:00 AM

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Manager Care Coordination
  • Hirenexus Research
  • San Francisco, CA
  • Manager Care Coordination Population Health San Francisco Bay Area Here are some of the benefits our client offers! HUGE...
  • 4/25/2024 12:00:00 AM

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Case Manager (Care Coordinator)
  • Pacifica Hospital of the Valley
  • Los Angeles, CA
  • Job Description Job Description CARE COORDINTOR (CASE MANAGER) BEHAVIORAL HEALTH URGENT CARE CENTER (OUTPATIENT CLINIC) ...
  • 4/24/2024 12:00:00 AM

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RN Utilization Management Managed Care Coordinator
  • Professional Management Enterprises
  • Columbia, SC
  • Job Description Job Description Seeking an RN with Managed Care and Utilization Management experience to review and eval...
  • 4/24/2024 12:00:00 AM

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Manager Care Coordination
  • hireneXus Research
  • San Francisco, CA
  • Manager Care Coordination Population Health San Francisco Bay Area Here are some of the benefits our client offers! HUGE...
  • 4/23/2024 12:00:00 AM

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office manager/ care coordinator
  • 5 Stars Home Care LLC
  • Alexandria, VA
  • Job Description Job Description Job Summary: Duties: Responsible for all areas of Operations; human resources, intakes, ...
  • 4/23/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Wilkes Barre, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Wilkes-Barre, Pennsylvania Job Category: RN ...
  • 4/22/2024 12:00:00 AM

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RN - Registered Nurse Case Manager - Care Coordination
  • Geisinger
  • Hughesville, PA
  • Job Title: RN - Registered Nurse Case Manager - Care Coordination Location: Danville, Pennsylvania Job Category: RN - Re...
  • 4/22/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Coordinator jobs
$49,162 to $84,369

Managed Care Coordinator in New Orleans, LA
Health systems must meet the operational challenge of managing provider data for thousands of participating providers in their value-based care networks.
January 11, 2020
Managed Care Coordinator in Gainesville, FL
Many telehealth programs give patients easy access to any additional educational materials provided by their health plan or primary care provider.
December 23, 2019
Managed Care Coordinator in Houston, TX
Works with relevant parties to ensure deliverable from all parties are achieved in accordance with strategic timelines.Maintains CHSLI master list of service locations (facility, professional and continuing care)Assists in the resolution of referral, authorization and claims payment issuesSupports Directors in effort to educate and assist Hospital departments in meeting internal and MCO operational requirements.
December 27, 2019