Easter Seals Jobs

Description

We are seeking an experienced Managed Care Coordinator to join our Managed Care Department on a temporary basis, potentially until the end of the year. This professional will engage in essential coordination and management duties associated with ancillary and health plan agreements for our hospital.

Job Requirements:

• Qualified candidates must have experience in negotiating one-time agreements like MOUs and LOAs for our network cases.

• Applicants should possess direct knowledge and experience with State and Federal laws, and regulations pertinent to healthcare, including HIPAA, DMHC, DHCS, and CMS.

• Successful candidates should have excellent leadership and negotiation skills and a comprehensive understanding of managed care contracting rates for network providers, services, and facilities.

• Applicants should possess the ability to excel under high-stress conditions, be highly organized and pay special attention to detail.

• Ability to read, analyze and interpret industry-related journals, financial reports, and legal documents is required.

• Proficiency in managing customer queries and complaints effectively and liaising with regulatory agencies or members of the business community.

• Proficiency in Microsoft programs including Word, Excel, Outlook, and accounting software is a must.

• Candidate should have excellent communications skills. He/She should write reports, business correspondence, and effectively present information to top management, clients, external groups, and/or boards of directors.

• Should track and trend CAP member performance collaborating with Management Service Organization and participate in JOC meetings.

• Must possess the ability to do contract modelling and review and prepare documentation for CAP potential legal cases.

If you are a committed, detail-oriented professional with proven ability in managed care coordination, we encourage you to apply for this role.

Requirements

• Bachelor's degree in healthcare administration, business, healthcare management or related field.

• 3-5 years of experience in managed care, healthcare or similar role within a hospital setting.

• Comprehensive knowledge of State and Federal laws including HIPAA, DMHC, DHCS, and CMS regulations.

• Proven negotiation and leadership skills.

• Experience with managed care contract rates for network providers, services, and facilities.

• Ability to operate under high-stress situations and to be exceptionally organized with an eye for detail.

• Proficiency in reading, analyzing, and interpreting common industry-related journals, financial reports, and legal documents.

• Proficiency in responding to inquiries or complaints from customers, regulatory agencies, or members of the business community.

• Advanced computer skills with proficiency in Microsoft Word, Excel, Outlook, and accounting software.

• Excellent written and verbal communication skills.

• Familiarity with CAP member performance tracking and Management Service Organization collaboration.

• Experience with JOC meeting participation, and contract modeling.

• Knowledge of preparing documentation for potential legal cases related to CAP.

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