Healthcare Professional

1 day ago


Duluth, Minnesota, United States Essentia Health Full time

We are seeking a dedicated and skilled Managed Care Specialist to join our team at Essentia Health. This role requires a strong understanding of managed care programs and the ability to work collaboratively with third-party administrators, health care agreements, and clinical areas.

Job Summary

  • Conducts Managed Care Programs in conjunction with third-party administrators' health care agreements.
  • Works collaboratively with Access Coordinators to perform all aspects of managed care, including referral, prior authorization/precertification processes, using and revising Essentia Health's established policies and procedures for managed care activities.
  • Performs complex care coordination and referral management.
  • Supports efforts and participates with the Supervisor of Contracting & Payor Relations and the Health Plans Medical Directors regarding health care initiatives and compliance issues for health plans.

Requirements

  • BSN or ADN degree from an accredited school or college of nursing.
  • Current nursing licensure in state(s) of employment.

What We Offer

  • Tuition Reimbursement/Assistance Program.
  • Paid Personal Leave.
  • 401k (with Essentia Health annual match).
  • Life and Disability Insurance options.
  • Adoption Assistance.
  • Employee wellness program.
  • Medical & Dental insurance options.

About Our Location

Our Business Service Center is located in Duluth, Minnesota, offering a unique blend of urban and natural attractions. With a range of cultural and recreational activities, Duluth provides a great quality of life for our employees.

Compensation

The estimated hourly compensation range for this position is $33.21 - $49.82 per hour.



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