Job description

OUR VISION

To continue as an eminent healthcare provider on Long Island, dedicating ourselves to providing exceptional health care for all our patients and to transform both the lives of the individual, and the community, for the better, one person at a time.

OUR MISSION

To provide access to equitable, optimal healthcare by improving the overall wellness of all individuals in our communities and delivering high quality comprehensive patient centered care.

OUR VALUE PROPOSITION

To provide whole person care that will ensure that all patients have access to primary, specialty and social health care to achieve and maintain optimal wellness at a transparent and affordable cost.

JOB TITLE: Population Health Specialist, Population Health

REPORTS TO: Vice President, Population Health

The following statements reflect the general duties, responsibilities and competencies considered necessary to perform the essential functions of the job and should not be considered as a detailed description of all the work requirements of this position.

POSITION SUMMARY:

The Population Health Coordinator performs all support functions to achieve goals and outcomes within the Population Health Department.

RESPONSIBILITIES:

The Managed Care Specialist - provides a variety of Managed Care program support and administrative/staff support services to Vice President Population Health. Primary focus will be on coordinating Managed Care Activities.

Essential Duties and Responsibilities:

* Managed Care Program Support duties:
* Develop and enhance existing Population Health programs
* Participate in managed care meetings
* Support Managed Care core functions (e.g., data entry, Quality reporting, claims research/updates, generating and managing data reporting, etc.)
* Partner with colleagues (internal to Harmony Health Care, i.e., Providers, Practice Managers, Nurse Managers, Care Management, Front Line Staff, Finance, Compliance, Enrollment, IT, etc.), as well as external, i.e., Managed Care Organizations and Community Partners in the evaluation, communication/outreach and support of non-compliant members, providers, and groups.

* Maintain continuous communication with Managed Care partners to ensure all service program expectations are continually met and maintained

* Troubleshoot and resolve service issues through appropriate channels

* Resolve Managed Care inquiries from internal and external stakeholders for Pharmacy, Medication Monitoring, Durable Medical Equipment, Home Health, Transportation and other services.

* Understand and communicate of Managed Care technology and workflow processes (quality initiatives, cost and utilization)

* Participates in QA/UM PR Committee meetings.

* Participates in educational sessions for physicians on issues identified during QI and/or HEDIS processes.

Administrative/Staff support services include clerical and support duties for the department.

Responsibilities include:

*Manage Calendar for VP of Population Health, schedule appointments skills.

*Maintain business spreadsheets, including quality scorecards (Excel skills Required)

* Maintain, organize and upload documents on shared sites (technical and organizational skills).

Required:

* Bachelors' degree; 3 years of direct insurance industry experience.
* General knowledge of managed care industry.
* Excellent written and oral communication skills.

SALARY: Commensurate with experience

MORE INFORMATION: This is an exempt position.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to perform a range of physical activities that are essential to the core work functions outlined in this document.

Job Type: Full-time

Pay: $52,675.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Research: 2 years (Preferred)
• Public health: 3 years (Preferred)

Language:

• Spanish (Preferred)
• Haitian Creole (Preferred)

Work Location: One location

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