What are the responsibilities and job description for the Managed Care Specialist position at Culinary Health Fund?
UNITE HERE HEALTH serves over 200,000 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 specialist 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. They will work towards becoming a subject matter expert on the relationships and contract terms that they are responsible for overseeing.
Essential Job Functions And Duties
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a hybrid employee.
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
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 specialist 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. They will work towards becoming a subject matter expert on the relationships and contract terms that they are responsible for overseeing.
Essential Job Functions And Duties
- Build relationships with managed care partners to facilitate problem identification and resolution, set expectations and evaluates performance
- Assists with negotiating renewals with managed care partners and services providers and works to capture key initiatives in contracts
- Thorough reviews and edits of managed care contracts
- Coordinates and ensures compliance with the UHH monitoring policy
- Analyzes data and drafts resolutions for Board of Trustees approval
- Possesses a working knowledge of the Request for Proposal (RFP) process
- Contributes to identifying and providing solutions of recurring or systemic issues
- Exemplifies the Fund’s values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement
- 3 to 5 years of direct experience minimally in healthcare, managed care, or insurance environments
- Working knowledge and experience in relationship building and contract negotiations
- Strong verbal communication and presenting experience
- Experience in project management processes
- Familiarity and experience working within union and Taft Hartley Funds, desired
- Bachelor’s degree in Business Administration, Public Health, Healthcare Administration or related field or equivalent work experience required
Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a hybrid employee.
We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).
Salary : $70,500 - $88,200