Managed Care Specialist

Essential Job Functions And Responsibilities

• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Monitors, coordinates, and evaluates complex treatment plans of assigned claimants to provide appropriate, effective, and cost-efficient care.
• Coordinates with vendors and healthcare providers to facilitate the treatment process including assessing and reviewing complex treatment plans and care facilities to ensure they meet the necessary medical standards and guidelines.
• Leads case management activities, including detailed documentation, follow-ups, and in-depth reporting on claimant progress.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.

Job Requirements

• Education: Bachelor’s degree in Healthcare Management, Nursing, or a related field. R.N. (Registered Nurse) or L.P.N. (Licensed Practical Nurse) preferred.
• Experience: Generally, a minimum of 10 years of case management or managed care experience.

Core in-office days

Core in-office days are Tuesday – Thursday, with the fourth day determined by business needs.

Benefits

• Medical, dental, and vision coverage
• Wellness plans
• Paid time off and paid holidays
• 401(k) plan with company match
• Employee stock purchase plan
• Commuter benefits

Compensation

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs.