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Managed Care Specialist

Weill Cornell Medical College

New York, NY
Weill Cornell Medical College
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Job Details

Position Summary

Under direction, the managed care specialist serves as the liaison for research and resolution of issues and problems related to health plan network of managed care contracted plans\. The specialist also works closely with Physician Organization Business office, clinical departments, and staff to communicate and implement terms of the managed care contracts\.

Job Responsibilities

+ Serves as a liaison for PO & IPA physicians, their staff & PO Administration to research and resolve issues related to plan policies, payment, participation status, performance and shared saving program, and processes and procedures of managed care plans\.

+ Develops and implements communication and education strategy on health plan policies and issues for PO and IPA\.

+ Tracks, documents, and communicate progress of outstanding issues\. Meets regularly with clinical departments and Business Office staff to review key issues and concerns\.

+ Supports arrangements for organ transplants and other high cost high acuity cases and/or global payments and international patients including negotiation of contract language\. Responsible for communication and education about these arrangements\.

+ Works with internal stakeholders to implement terms of the managed care contracts\. Assists and supports manager in activities necessary to manage contracts\.

+ Serves as a liaison for Managed Care Enrollment and Payer Compliance staff on contract provisions and policies by providing updates and educating staff on impact of changes\.

+ Maintains and updates contract language grid\.


+ Bachelor's Degree in related field


Four years of related experience can be substituted for a Bachelors Degree\.

Advanced knowledge of Microsoft Office Suite\.

Knowledge, Skills and Abilities

+ Experience with provider relations, claims review and/or denials resolution\.

+ Knowledge of regional and national managed care contracting requirements, Federal and State legislation governing managed care, insurance contracting, and operations knowledge of regional managed care operations and claim policies\.

+ Previous experience in an academic medicine setting Flexibility, tolerance and demonstrated ability to take initiative and to prioritize multiple tasks with attention to detail\.

+ Ability to function at a fast pace and continually interact with a wide variety of people and situations while maintaining a customer focus\.

+ Comfortable seeking direction and assistance from appropriate resources\.

Licenses and Certifications

Working Conditions/Physical Demands

Standard office work\.

Weill Cornell Medicine is a comprehensive academic medical center that's committed to excellence in patient care, scientific discovery, and the education of future physicians in New York City and around the world\. Our doctors and scientists\-faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization\-are engaged in world\-class clinical care and cutting\-edge research that connect patients to the latest treatment innovations and prevention strategies\. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U\.S\. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey\. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork\-Presbyterian Hospital/Weill Cornell Medical Center, NewYork\-Presbyterian/Lower Manhattan Hospital, and NewYork\-Presbyterian/Queens\. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients \- the center of everything we do\. Weill Cornell Medicine is an Equal Employment Opportunity/Minorities/Females/Vet/Disabled employer\.
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