• Senior Managed Care Specialist

    Job Locations US-IL-Aurora
    Posted Date 2 months ago(12/5/2018 4:48 PM)
    # of Openings
    Healthcare Delivery
  • Overview




    Looking for a way to influence the health and healthcare of many?


    If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.


    UNITE HERE HEALTH serves 100,000+ workers, 220,000 covered lives 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!



    Key Attributes:


    • Integrity – Must be trustworthy and principled when faced with complex situations
    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
    • Communication – Ability to generate concise, compelling, objective and data-driven reports
    • Teamwork – Working well with others is required in the Fund’s collaborative environment
    • Diversity – Must be capable of working in a culturally diverse environment
    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise
    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)



    The Senior Managed Care Specialist manage multiple Managed Care Vendor relationships as well as various bid and data analysis projects. This includes, working with managed care vendors and providers, conducting Requests for Proposals (RFP’s), reviewing and negotiating contracts, implementing and managing healthcare delivery projects, conducting analysis projects and more.

    • Builds relationships with contracted providers and managed care vendors to facilitate problem identification and resolution
    • Coordinates resolution of vendor/provider issues.
    • Coordinates contract compliance and maintains the Trustees’ vendor monitoring process
    • Works with vendors and staff to assist in implementations and various other projects 
    • Designs and develops benefit and/or provider/managed care vendor analysis reports
    • Analyzes and drafts data and resolutions for Board of Trustee Meetings
    • Negotiates contracts
    • Identifies and analyzes healthcare trends
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job
    • Performs Essential Job Functions and Duties with or without reasonable accommodation



    Education and Certifications

    • Bachelor's degree in Healthcare or related field or equivalent work experience required
    • Preferred: Master’s degree in Healthcare or related field
    • Preferred: License in Nursing (RN, CPA)
    • Valid driver’s license

    Knowledge and Experience

    • 5 ~ 7 years of direct experience minimum in healthcare, managed care or insurance environment
    • Working knowledge and experience in relationship building and contract negotiations with providers/vendors
    • Working knowledge and experience in written and verbal communication and presenting
    • Working knowledge and experience in project management processes
    • Experience in data analysis and report writing
    • Working knowledge of managed care/healthcare insurance

    Essential Skills and Abilities  

    • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
    • Advanced level Microsoft Excel skills
    • 10% ~ 15% travel
    • Communication skills (written and verbal)
    • Problem-solving, analytical and evaluation skills
    • Time management skills
    • Ability to review and negotiate vendor contracts
    • Ability to effectively communicate, prepare and present documents and presentations or projects in front of groups


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