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Managed Care Specialist

Managed Care Specialist

Job Category: Administrative/Clerical
Division: Torrance Memorial Health System
Position Type: Full time
Shift Length: TBD
Location: Torrance, CA

Resumes go to: rory.zatyko@tmmc.com

Torrance Memorial Health System is currently accepting applications for a Managed Care Specialist to join our team. Under the direction of the Vice President of Managed Care and Decision Support Manager, this position provides administrative support to the Managed Care Department.

Primary duties and responsibilities:

  • Management of contract files. Responsible for the filing and distribution of new contracts and contract amendments to health plans and affected internal departments. Also responsible for tracking of contract documents as they flow through the contract approval and signature process.
  • Responsible for maintaining the Managed Care Department’s contract renewal calendar, contacts list, and consolidated rate summary for all health plan agreements for TMMC, THIPA, TMPN, THH, and TSC.
  • Follows up on credentialing requests and helps assemble and distribute other documents as needed. Supports Decision Support Manager with obtaining and distribution of rate schedules and applicable fee schedule for loading (NThrive, Cymetrix & AMM).
  • Assists the Vice President of Managed Care with the negotiation of patient-specific letters of agreement (LOAs) with health plans that are not contracted with Torrance Memorial Medical Center.
  • Acts as a hospital liaison to health plans and medical groups to address and resolve ongoing operational and contract administration issues related to managed care contracts. Works with medical group’s referral and Utilization Management staff, as appropriate, to address issues related to member benefits, provider service issues, authorization and U.R. requirements, communication mechanisms and system issues. Assists Decision Support Manager with assessment and tracking of contract loads into NThrive.
  • Performs basic clerical and general office duties such as receiving visitors, answering and screening telephone calls, typing correspondence, filing, retrieving and distributing mail.
  • Types correspondence and provides project support, coordinates meetings, prepares agendas, minutes, and lists of follow up action items.
  • Coordinates facilities and general office support.
    • Coordinates facility maintenance requests – interfacing with external vendors and property manager as needed.
    • Ensures that supplies are managed.
    • Maintains an organized and orderly environment.
    • Coordinates with HR for personnel security/badge access.
  • Conducts supervised research, and works on specific contracting and marketing projects as needed.
  • Demonstrates behaviors that are consistent with the values of service, excellence, knowledge, stability and community. Demonstrates good customer relations skills.
  • Ensures that privacy and confidentially rules are followed in accordance with the Health System, State, Federal and HIPAA regulations.

Requirements:

High School Diploma/GED required. AA highly desirable

  • Three years’ experience required; in a law firm, legal department, business office, or other healthcare managed care setting preferred
  • Excellent word processing skills
  • Proficient at developing presentation materials
  • Proficient in Excel
  • Excellent proof reading skills and grammar skills.
  • Strong research skills.
  • Excellent organizational skills and the ability to manage multiple projects at once.
  • PC experience including Microsoft Outlook, Word, Excel, PowerPoint, and similar software programs.
  • Strong interpersonal and communication skills. Is capable of interpreting executive level communication in to specific deliverables.
  • Able to type 55 words per minute

Qualified candidates should submit their resume to rory.zatyko@tmmc.com for consideration.