Supervisor, Program Coordination

Location: Pittsburgh, PA
Supervisor, Program Coordination
 
Joining this team means you'll be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. The group is a fast, agile, customer-focused organization with a commitment to implementing the latest technologies.
 
Our client serves more than 55 million managed care members through their portfolio of high-quality commercial and government sponsored healthcare programs. The broad offering of programs that they provide has helped them to build both capacity and capability to successfully navigate a changing healthcare environment, while continuing to offer better health outcomes at lower costs.
 
Position Purpose:
Perform collaborative duties for the development and implementation of all Coordinated Care programs (OB/NICU, Asthma, Diabetes, ER, General/Catastrophic); Provide support and supervision to ensure quality and continuity of services delivered to Members, Providers and staff.
 
Job Description:
  • Develop and oversee aspects of coordinated care program activities
  • Develop and implement management software and reporting mechanisms for specific outcome measurement and data reporting
  • Identify referrals for coordinated care programs.
  • Develop plan specific literature and educational components for member and provider distribution.
  • Oversee contract negotiation and execution components for Prenatal Coordinated Care (PNCC) entities
  • Collaborate with various departments to extract data for identification of program members and to report program outcomes
  • Identify processes and work flow improvements to foster efficient and effective case management efforts
  • Monitor distribution of members identified for case management to ensure positive results and program success
 
Qualifications:
Education/Experience:
  • High school diploma or equivalent.
  • 5+ years of prior authorization, physician's office, customer service, claims processing or provider relations experience preferably in a managed care setting.
  • Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
 
Preferred Skills/Experience:
  • Two or more years of supervisory experience in a call center environment, and  managed care experience.
 
Licenses/Certifications:
  • N/A
 
Our client offers options that allow you to do more than just plan for retirement. Their programs allow shared success with employees.
  • 401(k) with company match
  • Employee stock purchase plan
  • Training and Learning Opportunities/Tuition Reimbursement/Educational Assistance
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
 
Equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
 
 
 
 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 
https://www.indeedjobs.com/proenlist?hl=en_US
 
 
or
this job portal is powered by CATS