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.

The Harmony Healthcare Long Island, formerly known as (Long Island Federally Qualified Health Center or LIFQHC) is a non-profit healthcare organization with 7 health centers, providing primary care and preventative medicine in the following locations in Nassau County: Roosevelt, Elmont, Hempstead, Freeport, Oceanside, and New Cassel/Westbury. In addition, the Harmony Healthcare Long Island has 3 school-based health centers, WIC offices (Special Supplemental Nutrition Program for Women, Infants, and Children) in 3 locations, and a Health Home Care Coordination program. As federally qualified health centers, we serve the individuals in our communities, providing enhanced services, expanded hours and reduced prescription pricing, while raising the level of care. We treat patients regardless of income, residency or immigration status.

The Harmony Healthcare Long Island offers a stable employment opportunity with a growing company, and competitive base compensation along with health and dental insurance, paid time off, 401-K with company match, paid holidays, employee discounts and much more.

JOB TITLE: Managed Care Specialist

REPORTS TO: Vice President Population Health

RESPONSIBILITIES:

The Managed Care Specialist - provides a variety of Managed Care program support services to the Population Health Department. Primary focus will be on coordinating Managed Care related activities and analysis.

Essential Duties and Responsibilities:

• Support Managed Care core functions (e.g., data analysis, Quality reporting, claims research/updates, generating and managing data reporting, etc.)
  Coordinate and participate in managed care meetings.
• 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 related to patient satisfaction, medical records, Medication Monitoring, and other services.
• Understand and communicate Managed Care terminology and workflow processes (quality initiatives, cost and utilization)
• Participates in educational sessions for physicians on issues identified during QI and/or HEDIS processes.
• Participate in supplemental chart review and submission.
• Maintain business spreadsheets, including quality scorecards.
• Maintain, organize and upload documents on shared sites.
• Partner with colleagues (internal to Harmony Healthcare, 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.
• Excel and analytical skills required.
• Technical and organizational skills required.

Required:

Bachelors' degree: 3 years of direct insurance industry experience.

General Knowledge of managed care industry.

Excellent written and oral communication skills.

Knowlege of Excel a must.

SALARY:

MORE INFORMATION:

Harmony Healthcare Long Island provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, gender, marital status, sexual preference and orientation, or non-disqualifying physical or mental handicap/disability in each aspect of the human resources function. Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The Harmony Healthcare Long Island shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.