Managed Care Specialist

Job Description

Catapult Consultants is hiring a Managed Care Specialist to provide subject matter expertise and technical assistance on matters related to Managed Care operations, policies and regulations. This person will support the Data Analysis, Medical Review, Program Integrity, and Request For Information teams by consultation with staff and by participating in investigative and/or data analysis efforts.

Specific Duties:  

• Provides consultation and advice to staff relating to the operations, policies, guidelines and regulations of Managed Care Organizations (MCOs).

• Trains/Educates staff related to MCO operations and policies and provides continuing education updates to staff relating to the Managed Care field.

• Aides Program Integrity staff on the identification of fraud, waste and abuse in the MCO environment.

• Explains program specific procedures, guidelines and regulations to staff upon inquiry. 

• Compiles and maintains various documentation and other reporting requirements.  

• Communicates regularly with internal staff with appropriate written communications related to specific program information.

• Assists the Data Analysis, Program Integrity, Medical Review and Request For Information Managers and Supervisors by researching MCO coverage criteria, regulations, and policies.  

• Stays current with Medicaid fraud / abuse issues and vulnerabilities and recommends appropriate proactive analysis.

• Stays current with all Medi-Medi State’s MCO structure.

• Attends meetings with external customers as necessary.

• Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives

Qualifications

• Must be a graduate from an accredited U.S. college or university with a bachelor’s degree and/or experience equivalent to six years of professional level experience interpreting policy or procedural provisions for a health care entity.

• Must have a high proficiency level with Microsoft Word.  

• Needs working knowledge of Microsoft Excel and PowerPoint.  

• Should have excellent verbal and written communication skills.

• Should have excellent research skills including internet research.

• Must have the ability to work independently with minimal supervision.

• Must have the ability to perform multiple priority tasks.   

• Associate must have and maintain a valid driver’s license issued by his/her state of residence.

• Must have a minimum of three years of Managed Care related experience. 

Additional Information

EEO StatementCatapult Consultants is an Equal Opportunity Employer.  

We believe that every employee has the right to work in a dignified work environment free from all forms of discrimination and harassment.  It’s our policy to recruit, employ, retain, compensate, train, promote, discipline, terminate and otherwise treat all employees and job applicants based solely on qualifications, performance, and competence. This policy reflects our belief that providing equal opportunities for all employees is a both our legal and moral responsibility, and good management practice.
All employees and applicants are treated without regard to age, sex, color, religion, race, national origin, citizenship, veteran status, current or future military status, sexual orientation, gender identification, marital or familial status, disability or any other status protected by law.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.