Managed Care Specialist
Job Description
About the Role
Title: Managed Care Specialist
Location: Aurora United States
Job Description:
UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!
The Managed Care Specialist role functions as the main point of contact between the operational departments of UNITE HERE HEALTH and a wide range of managed care partners (contracted network carriers, vendors, and preferred providers). This position works closely with internal departments to help identify and resolve issues, implement new benefit platforms, and overall guide the relationship between UHH and our managed care partners.
The MCS supports UHH Leadership in holding managed care partners accountable for providing the highest level of services at the lowest cost to UHH and its members. The Managed Care Specialist works towards becoming a subject matter expert on the relationships and contract terms they are responsible for overseeing.
ESSENTIAL JOB FUNCTIONS AND DUTIES
Builds relationships with managed care partners to facilitate problem identification and resolution, set expectations and evaluate performance
Assists with negotiating renewals with managed care partners and service providers and works to capture key initiatives in contracts
Thoroughly reviews and edits managed care contracts
Coordinates and ensures compliance with the Fund’s monitoring policy
Works with vendors and staff to assist in implementation projects and other various Aurora Healthcare Delivery projects
Participates in implementation projects, with support from Supervisor and Project Sponsor. May act as the Business lead.
Analyzes data and drafts resolutions for Trustee approval
Possesses a working knowledge of the Request for Proposal (RFP) process
ESSENTIAL QUALIFICATIONS
3 ~ 5 years of direct experience minimum in healthcare, managed care, or insurance environment
Experienced in relationship building and contract negotiations
Experienced in written and verbal communication and presenting
Adept with project management processes
Skillful data analysis and report writing
Bachelor’s degree in Business, Healthcare Administration, or related field or equivalent work
Working knowledge of Unions and Taft Hartley Funds preferred
Pay range for this position: Salary $64,900 – $81,100. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.
Work Schedule (may vary to meet business needs): Monday through Friday, 7.5 hours per day (37.5 hours per week) as a remote, work-from-home role (with the exception of the first week of training onsite in Aurora, IL, and up to 3x’s a year, an onsite day in the office). The hours of the position will be 8-4 p.m.
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
