Description We are offering a long-term contract employment opportunity for a Managed Care Coordinator in the healthcare industry. Based in Van Nuys, California, this role involves coordinating managed care activities within a hospital setting, ensuring adherence to relevant regulations, and maintaining strong relationships with network providers and customers.

Responsibilities:

• Engage in negotiations on health plan agreements in the context of managed care, ensuring the best possible terms for the hospital.

• Facilitate the processing and negotiation of one-time agreements such as Memoranda of Understanding (MOUs) and Letters of Agreement (LOAs) for network cases.

• Maintain awareness of and compliance with State and Federal laws and regulations relevant to the healthcare industry, including HIPAA, Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and CMS.

• Analyze industry-related journals, financial reports, and legal documents to inform decision-making and strategy.

• Respond effectively to inquiries or complaints from customers, regulatory agencies, or members of the business community.

• Utilize Microsoft programs including Word, Excel, Outlook, and relevant accounting software to manage data and correspondence.

• Prepare and present reports to top management, clients, external groups, and/or boards of directors.

• Monitor and analyze the performance of CAP members in collaboration with the Management Service Organization.

• Participate actively in Joint Operating Committee (JOC) meetings to discuss and strategize on managed care issues.

• Conduct contract modeling to predict and assess the implications of different contract scenarios.

• Review and prepare documentation for potential legal cases related to the Contracted Assistance Program (CAP). Requirements • Extensive experience in the healthcare, hospitals, and social assistance industry

• Proficiency in using EHR (Electronic Health Records) systems

• Demonstrable experience in negotiating and managing care contracts

• In-depth knowledge of Medicaid managed care

• Experience in executing managed care plans and understanding of managed care industry

• Familiarity with medical billing processes

• Proven ability to handle appeals related to managed care

• Experience in managed care contracting and ability to negotiate contracts effectively

• Excellent communication, negotiation, and interpersonal skills

• Ability to work in a fast-paced environment and handle multiple tasks simultaneously

• Strong problem-solving abilities and decision-making skills

• Bachelor's degree in a related field is preferred

• Relevant certifications in healthcare management would be an advantage.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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