POSITION DESCRIPTION: The Managed Care Policy Specialist works together with the Reimbursement team to advance policy objectives that impact how skilled nursing facilities and other member providers are reimbursed by state government (e.g. Medicaid) and managed care health plans. This position serves as a subject matter expert on the requirements for the carve-in of long-term care services into managed care (e.g. CalAIM), and provides members with guidance for best practices to navigate the managed care environment.
We are looking for this person to:
1. Develop a thorough understanding of, and distinctions between, managed care contract requirements for skilled nursing facilities and developmental services providers.
2. Ensure that managed care plans consistently interpret policies and procedures in their contracts with long term care providers.
3. Actively monitor and analyze any significant changes or emerging trends made by managed care plans that could adversely impact long-term care providers and propose solutions to address challenges.
4. Serve as a liaison between providers, managed care community, and other stakeholders, and work to effectively resolve emerging system issues affecting providers.
5. Convene member work groups to gather input on experiences with managed care organizations.
6. Represent CAHF at community, chapter, local agency, and health plan-sponsored events and present on best practices and in helping guide members in this managed care payer environment.
7. Cultivate and maintain key stakeholder contacts in the managed care community and state regulatory agencies.
KNOWLEDGE, SKILLS AND EXPERIENCE
Bachelor’s degree or equivalent experience in a related field.
At least 3-5 years of experience in health care or related field.
Working knowledge of Medi-Cal program and/or health plan contracting.
Excellent communication (written and verbal), problem-solving and analytical skills.
Team player, collaborator, customer-service oriented, and strong people person.
Self-starter needed with ability to work independently with minimum supervision.
Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook).
PREFERRED: Significant knowledge or familiarity with a variety of the field’s concepts, practices and procedures such as – delivery of health care services, claims and authorization processes, long term care reimbursement, health care program financing, understanding of managed care contracting, skilled nursing operations, and/or health plan experience.
Statewide travel 0-25%
BENEFITS: Health, dental, life, 401(k), vacation, sick leave, designated holidays, hybrid work schedule.
TO APPLY:
Include cover letter with resumé regarding your qualifications.
