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Managed Care Coordinator

6010255

DSRIP

Melville
992 North Village Avenue Rockville Centre, NY 11570

Full Time

Day shift

Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.

Working with minimal supervision, the MCO(Managed Care Organization) Coordinator will be responsible for working with Managed Care Organizations, PPS partners, healthcare providers, practice managers and their teams. The Coordinator will work as the intermediary between the CHSLI DSRIP Project Management Office (PMO), CHSLI Payer Contracting leadership, primary care providers and their teams, IT, and other identified contracted/agreement entities in assisting in developing relationships, negotiating agreements, and creating data sharing avenues.

Responsibilities:

  • Establish strategic relationships between CHSLI DSRIP Office, CHSLI MCO relationship personnel, MCO partners, PPS management, and other necessary stakeholders
  • Assists System Director with MCO negotiations
  • Prepares contract highlight document and term sheets
  • Maintains and distributes VBP summary grids
  • Works closely with PPS, Hub, and MCO IT departments to ensure proper coordination and collaboration.
  • Engages Medicaid MCO's to ensure deliverables from all parties are achieved in accordance with strategic timelines
  • Lends support and participates in discussions regarding data collection, data analysis and methodology for the program
  • In coordination with DSRIP PMO Leadership, tracks, and reports the engagement and activity of the CHS MCO provider network Works as liaison between, CHS DSRIP Project Management Office, IT, and other key stakeholders to ensure accurate communication about requested information and that the most effective and efficient data collection efforts are achieved
  • Participates in DSRIP Payer Contracting Workgroups as assigned
  • Ability to perform requested tasks with minimal direction
  • Participates in continuing education programs to enhance job knowledge as needed
  • Ability to use critical thinking and apply sound judgment and assessment skills for decision making
  • Employee conducts himself/herself in conformity with the HIPAA Compliance Program and applicable institutional policies and procedures for patient privacy. In addition, employee conducts himself/herself in conformity with CHS Security Policies and Procedures
  • Participates in DSRIP PPS meetings as requested
  • Maintains current knowledge of DSRIP requirements

Requirements:

  • Bachelors Degree Required
  • Excellent communication (oral and written) and interpersonal skills
  • Excellent problem solving skills, conflict resolution and customer satisfaction skills
  • Demonstrates ability to negotiate and finalize agreements
  • Demonstrates ability to anticipate problems
  • Proficiency in Microsoft Office (Word, Excel, Power Point)
  • Detail Orientated and Organized
  • Interdisciplinary team work experience
  • Typical office environment. Standing, walking and/or continuously moving around
  • Significant travel around Long Island
  • 5 years post BA work experience, healthcare industry required. Strong candidate will demonstrate negotiation and/or sales experience

At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.