Managed Care Finance Director jobs in Pennsylvania

Managed Care Finance Director directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Being a Managed Care Finance Director implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Additionally, Managed Care Finance Director typically reports to top management. The Managed Care Finance Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Managed Care Finance Director typically requires 5+ years of managerial 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
  • 16 Days Ago

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Director of Managed Services
  • Latitude, Inc.
  • Broomall, PA FULL_TIME
  • Director of Managed Services Main Points Mostly onsite position in Broomall, PASalary: 100k-140k depending on experience "command" and "control" experience required Overview:The Director of Managed Se...
  • 24 Days Ago

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Director, Managed Services
  • IT Solutions Consulting LLC
  • Fort Washington, PA FULL_TIME
  • About Us: IT Solutions Consulting, LLC is a Managed Services and Application Development company with over 25 years of experience. We provide reliable and secure IT support and strategic technology gu...
  • 1 Month 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...
  • 26 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

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 Finance Director jobs
$142,352 to $183,938

Managed Care Finance Director in Waterloo, IA
Today, the Department of Health Care Finance (DHCF) announced that the Office of Contracting and Procurement (OCP) submitted to the Council of the District of Columbia a notice of intent to award three contracts for the District’s Medicaid managed care program.
January 27, 2020
Managed Care Finance Director in Biloxi, MS
Our executives lead the strategies and operations that help us deliver quality care across our network.
January 30, 2020
Managed Care Finance Director in Reno, NV
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties.
December 30, 2019
Able to travel to all regional sites in a consistent, timely and efficient manner; holds effective meetings and leads workgroups, assigns and takes over deliverables, reports to and coordinates with the regional director and manager on the priorities and workload management; strives to exceed expectations.
January 24, 2020