Managed Care Marketing Manager jobs in Johnstown, PA

Managed Care Marketing Manager develops and implements marketing plans for a managed care organization. Promotes the organization's services to potential members and business partners. Being a Managed Care Marketing Manager identifies and targets new opportunities and sources of additional business and revenue. Requires a bachelor's degree. Additionally, Managed Care Marketing Manager typically reports to a head of a unit/department. The Managed Care Marketing Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Managed Care Marketing Manager typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

E
SPECIALST MANAGED CARE PTE
  • Excela Health Latrobe Hospital
  • Latrobe, PA FULL_TIME
  • Job Summary

    The Managed Care Specialist serves as the managed care liaison by submitting clinical information and obtaining managed care authorizations for acute care patients through communication with representatives of managed care organizations. Collaborates with Unit Based Case Managers and/or Physicians to determine acute care criteria prior to contacting managed care organizations. Knowledgeable of all payor notification requirements. Works with Patient Accounting Department for resolution of payor reimbursement issues. Facilitates denial management by working with the Physician Advisor and the Denial Managers to ensure appropriate documentation of activities to maximize positive financial outcomes.

    Essential Job Functions

    • Managed Care Liaison
      • Conducts electronic and telephonic reviews (admission, continued stay, and retrospective reviews) with managed care organizations for urgent or unplanned acute care patient admissions to secure payor authorization and subsequent reimbursement for clinical services. Documents and communicates authorization and need for continued stay reviews to the Unit Based Case Manager for all admissions. Communicates all payor determinations to Patient Accounting via Star and other information systems as needed.
      • Communicates and documents adverse payor determinations in a timely manner to the appropriate CRM staff member and assists with the appeal process as required.
      • Documents payor/authorization information into Star, Care Manager, and other hospital systems as required.
      • Identifies potential problems with securing authorization and seeks resolution with the Unit Based Case Manager and Department Manager.
      • Collaborates with Pre-Admission office to verify appropriate bedding of incoming patients and assures that pre-admission authorizations are obtained.
      • Collaborates with Patient Accounting Department and other ancillary departments for up to date payor information and their contact number(s).
      • Provides patient demographics to managed care companies daily for required financial classes.
    • Utilization Management
      • Possesses current and accurate working knowledge of InterQual Level of Care Criteria and other criteria as necessary to receive acute inpatient approval of a specific patient's case.
      • Communicates any changes pertaining to criteria to all appropriate parties.
      • Performs retrospective reviews on discharged patients requiring certification, including but not limited to late Medical Assistance pick-ups, new Medical Assistance beneficiaries, and urgent/unplanned admissions/discharges from the weekend. Confers with all physicians prior to third party payor interface.
      • Communicates pay class changes to unit based case manager on concurrent patients, assists denial specialist with post-discharge pay class changes.
      • Communicates regularly with other departments who impact payor information and changes to patient information related to payor source.
      • Keeps updated list of payor contacts and communicates this information to CRM staff in a timely manner.
      • Assists Case Managers by being a resource person for payor specific timeframes from authorization/certification.
      • Serves as a resource for the unit based Case Managers on medical necessity, ensuring their reviews are comprehensive and complete concurrent cases.
      • Maintains current data base tracking closed out cases and placing patient authorizations into STAR for all third party payors requiring certification.
    • Denial Management
      • Initiates contact with Attending Physician and Physician Advisior on retrospective cases for clarification of intent.
      • Notifies the Denial Management Specialist of all real or potential cases in which an adverse determination has been rendered or is anticipated by the payor.
      • Tracks denials and refers to the Denial management Specialist if decision is still outstanding from the payor.
      • Maintains patients' rights by adhering to HIPPA and other regulatory agency requirements.
    • Maintains current denial daily data base and prints denial sheets out daily for the Manager to review with staff the following morning.
    • Maintains a weekly database of the Failed Bill and is responsible for keeping this to the minimum amount possible.

    Required Qualifications

    • Graduate of accredited nursing program.
    • Two (2) years of acute care clinical nursing experience or case management/utilization review experience.
    • Knowledge of Payor/Insurance Benefits
    • Knowledge of basic Office Equipment such as copier, fax machine, etc.
    • Strong Analytical, Data Management and PC skills.
    • Ability to work independently and exercise sound judgement in interactions with payors, physicians, and other members of the health care team.
    • Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment
    • Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.

    Preferred Qualifications

    • Working knowledge of Performance Improvement concepts.
    • One (1) to two (2) years of case management or utilization review experience preferred.
    • Case Management Certification
    • Working knowledge of InterQual Level of Care Criteria, utilization management and reimbursement guidelines

    License, Certification & Clearances

    • Current licensure to practice as a Registered Nurse in the State of Pennsylvania.
    • Act 34-PA Criminal Record Check from the PA State Police system

    Supervisory Responsibilities

    • This position has no direct supervisory responsibilities, but does serve as a coach and mentor for other positions in the department.

    Position Type/Expected Hours of Work

    • Incumbent will be scheduled based on operational needs ( weekdays, weekends, etc.).
    • Travel may be expected locally between Excela Health locations.

    LEAN

    • Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements. Recognizes the necessity of taking ownership of one’s own motivation, morale, performance and professional development. Strives for behavior consistent with being committed to Excela’s missions, vision and values.

    AAP/EEO

    • Excela Health is an Equal Opportunity Employer. It is the policy of Excela Health to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants, without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, veteran status, or genetic information, or any other protected class. Excela Health will conform to the spirit as well as the letter of all applicable laws and regulations.
    • Ability to perform the Essential Functions listed on the Physical Conditions and ability to perform the Essential Functions on the Working Condition chart below.

    Work Environment

    Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines

    When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.

    Essential – Absolute Necessity.

    Marginal – Minimal Necessity.

    Constantly – 5.5 to 8 hours or more or 200 reps/shift.

    Frequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.

    Occasionally – 0.25 to 2.5 hours or 2-32 reps/shift.

    Rarely – Less than 0.25 hours or less than 2 reps/shift.


    Physical Condition


    Essential


    Marginal


    Constantly


    Frequently


    Occasionally


    Rarely


    Never


    Extreme Heat


    x


    Extreme Cold


    x


    Heights


    x


    Confined Spaces


    x


    Extreme Noise(>85dB)


    x


    Mechanical Hazards


    x


    Use of Vibrating Tools


    x


    Operates Vehicle (company)


    x


    Operates Heavy Equipment


    x


    Use of Lifting/Transfer Devices


    x


    Rotates All Shifts


    x


    8 Hours Shifts


    x


    x


    10-12 Hours Shifts


    x


    x


    On-Call


    x


    Overtime( 8/hrs/shift; 40/hr/wk)


    x


    Travel Between Sites


    x


    x


    Direct Patient Care


    x


    Respirator Protective Equipment


    x


    Eye Protection


    x


    Head Protection (hard hat)


    x


    Hearing Protection


    x


    Hand Protection


    x


    Feet, Toe Protection


    x


    Body Protection


    x


    Latex Exposure


    x


    x


    Solvent Exposure


    x


    Paint (direct use) Exposure


    x


    Dust (sanding) Exposure


    x


    Ethylene Oxide Exposure


    x


    Cytotoxic (Chemo) Exposure


    x


    Blood/Body Fluid Exposure


    x


    Chemicals (direct use) Exposure


    x


    Mist Exposure


    x


    Wax Stripper (direct use)


    x


    Non-Ionizing Radiation Exposure


    x


    Ionizing Radiation Exposure


    x


    Laser Exposure


    x


    Physical Demands

    When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.

    Essential – Absolute Necessity.

    Marginal – Minimal Necessity.

    Constantly – 5.5 to 8 hours or more or 200 reps/shift.

    Frequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.

    Occasionally – 0.25 to 2.5 hours or 2-32 reps/shift.

    Rarely – Less than 0.25 hours or less than 2 reps/shift.


    Physical Condition


    Essential


    Marginal


    Constantly


    Frequently


    Occasionally


    Rarely


    Never


    Bending (Stooping)


    x


    x


    Sitting


    x


    x


    Walking


    x


    x


    Climbing Stairs


    x


    x


    Climbing Ladders


    x


    Standing


    x


    x


    Kneeling


    x


    Squatting (Crouching)


    x


    x


    Twisting/Turning


    x


    x


    Keyboard/Computer Operation


    x


    x


    Gross Grasp


    x


    Fine Finger Manipulation


    x


    x


    Hand/Arm Coordination


    x


    x


    Pushing/Pulling(lbs. of force)


    x


    <10#


    Carry


    x


    <10#


    Transfer/Push/Pull Patients


    x


    Seeing Near w/Acuity


    x


    x


    Feeling (Sensation)


    x


    x


    Color Vision


    x


    x


    Hearing Clearly


    x


    x


    Pulling/Pushing Objects Overhead


    x


    Reaching Above Shoulder Level


    x


    x


    Reaching Forward


    x


    x


    Lifting Floor to Knuckle


    x


    <10#


    Lifting Seat Pan to Knuckle


    x


    <10#


    Lifting Knuckle to Shoulder


    x


    <10#


    Lifting Shoulder to Overhead


    x


    <10#



    When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.

    Education

    Required
    • Bachelors or better in NURSING

    Licenses & Certifications

    Required
    • REGISTERED NURSE

    Skills

    Required
    • BASIC OFFICE/COMPUTERS
    • EXCELLENT COMMUNICATION
    • DECISION MAKING ABILITY
    • FLEXIBILITY
    • INDEPENDENT THINKING
    • ORGANIZATIONAL SKILLS
    • PAYOR/INSURANCE BENEFITS
    • WORK IN TEAM ENVIRONMENT

    Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

    The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

  • 1 Month Ago

I
SPECIALST MANAGED CARE PTE
  • Independence Health System
  • Latrobe, PA PART_TIME
  • Job Summary The Managed Care Specialist serves as the managed care liaison by submitting clinical information and obtaining managed care authorizations for acute care patients through communication wi...
  • 1 Month Ago

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Office Manager - Nurse Managed Wellness Center
  • Allegany College of Maryland
  • Cumberland, MD FULL_TIME
  • Allegany College of Maryland is a high quality, low cost educational community college. Our attractive main campus is nestled on 317 beautiful, scenic acres in the mountains of Allegany County - Cumbe...
  • Just Posted

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Marketing Director
  • Alleghenies Unlimited Care Providers
  • Johnstown, PA FULL_TIME
  • Alleghenies Unlimited Care Providers is a rapidly growing organization that values diversity in everything we do. We are communicators, culture builders, entrepreneurially spirited, and operational ex...
  • 24 Days Ago

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Admission Marketing Manager
  • Saint Vincent College
  • Latrobe, PA FULL_TIME
  • Reports to: Vice President of Admissions & Marketing Supervises: Marketing & Communications Work Study Primary Functions: Responsible for enhancing the visibility, understanding and support of the Col...
  • 23 Days Ago

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Marketing Communication Manager
  • Verra Mobility
  • Indiana, PA FULL_TIME
  • Who we are... T2 Systems is the largest parking, mobility, and transportation provider in North America, with more than 25 years in the parking management industry and currently serving thousands of p...
  • Just Posted

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0 Managed Care Marketing Manager jobs found in Johnstown, PA area

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Regional Marketing Manager - Own a Franchise
  • Williamsonheckt
  • Johnstown, PA
  • Do you want to own your own business? You are not alone, approximately 85% of the new franchise owners were professional...
  • 3/29/2024 12:00:00 AM

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Regional Marketing Manager - Own a Franchise
  • Williamsonheckt
  • Indiana, PA
  • Do you want to own your own business? You are not alone, approximately 85% of the new franchise owners were professional...
  • 3/29/2024 12:00:00 AM

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Regional Marketing Manager - Own a Franchise
  • Williamsonheckt
  • Altoona, PA
  • Do you want to own your own business? You are not alone, approximately 85% of the new franchise owners were professional...
  • 3/29/2024 12:00:00 AM

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Regional Marketing Manager - Own a Franchise
  • Williamsonheckt
  • Meyersdale, PA
  • Do you want to own your own business? You are not alone, approximately 85% of the new franchise owners were professional...
  • 3/29/2024 12:00:00 AM

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Regional CRA Officer
  • First Commonwealth Bank
  • Johnstown, PA
  • Under the oversight of the Bank's Community Reinvestment Act (CRA) Officer, the Regional Community Reinvestment Act Offi...
  • 3/28/2024 12:00:00 AM

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District Manager - Retail Merchandising
  • Navytimes
  • Johnstown, PA
  • District Manager - Retail Merchandising At a glance Location: US-PA-Johnstown Posted: 02/21/2022 Closing: 03/20/2022 Deg...
  • 3/27/2024 12:00:00 AM

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Territory Manager Market Support
  • US Foods, Inc.
  • Greater Pittsburgh, PA
  • ESSENTIAL DUTIES AND RESPONSIBILITIES while covering for other Territory Managers: • Foster the customer relationship in...
  • 3/26/2024 12:00:00 AM

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Member Services Representative
  • Planet Fitness
  • Johnstown, PA
  • THE PLANET FITNESS MISSION We at Planet Fitness are here to provide a unique environment in which anyone, and we mean an...
  • 3/25/2024 12:00:00 AM

Johnstown is a city in Cambria County, Pennsylvania, United States, 43 miles (69 km) west-southwest of Altoona and 67 miles (108 km) east of Pittsburgh. The population was 20,978 at the 2010 census and estimated to be 20,402 in 2013. It is the principal city of the Johnstown, Pennsylvania, Metropolitan Statistical Area, which includes Cambria County. Johnstown is located in southwestern Cambria County at 40°19′31″N 78°55′15″W / 40.32528°N 78.92083°W / 40.32528; -78.92083 (40.325174, -78.920954). According to the United States Census Bureau, the city has a total area of 6.1 square miles (15....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Marketing Manager jobs
$80,329 to $111,284
Johnstown, Pennsylvania area prices
were up 1.5% from a year ago

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