Managed Care Specialist

4 weeks ago

Nashville, United States Spectraforce Technologies Full time
Title: Managed Care Specialist

Location: Nashville, Tennessee 37243

Duration: 6 Months

Description:

The client will recruit a new classification for MANAGED CARE PROGRAM MGR.

This Contractor position is critical to accomplishing LTSS ID Services Team outcomes related to ensuring that the 1915(c) and Select Community programs are operating at maximum performance and ensuring that upcoming federal reporting and waiver renewal/amendment deadlines are met. The Contractor is needed to assist the ID Services Team in conducting continuous analysis and evaluation of frequent and recurring reports/deliverables/related contract amendments in efforts to enhance program improvement, complete 1915(c) post-payment Utilization Reviews, update/analyze/validate federally mandated 1915(c) quality data monthly and perform careful review and contribution to the upcoming 2025 1915(c) waiver renewals.

MINIMUM QUALIFICATIONS

* Graduation from an accredited college or university with a bachelor's degree and experience equivalent to 3 years of professional level experience.

* Excellent Excel skills and experience with all other Microsoft Office Programs.

* Experience interpreting policy or procedural provisions for a Medicaid, or other related health insurance organization is preferred.

* Excellent written and oral communication skills

DESIRABLE QUALIFICATIONS

* Passion and commitment to supporting people with I/DD, person-centered practices, and integrated employment and community living

* Experience with program management and/or grant management

* Experience in contract management

* Experience working in or with Medicaid or disability related programs

* Strong work ethic and self-motived with ability to work well on a team

* Organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines

* Ability to adapt to changing priorities and deadlines

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