Managed Care Subject Matter Expert

Catapult Consultants, LLC; Nashville (TN); On-site; USD 70,000 - 90,000; Full time

Job summary

Catapult Consultants, LLC is seeking a Managed Care Subject Matter Expert in Nashville, TN, to provide expertise and support on Managed Care operations. The role involves advising staff, training on MCO policies, and assisting with fraud identification. Candidates must have a bachelor's degree or significant experience in interpreting health care policies, along with proficiency in Microsoft applications.

The ideal candidate will be knowledgeable in the Managed Care field and possess excellent communication and research skills. A valid driver’s license is also required.

Qualifications

• Graduate from an accredited U.S. college or university.
• Experience equivalent to six years in healthcare policy.
• Minimum of three years of Managed Care experience.

Responsibilities

• Provides consultation on Managed Care operations.
• Trains staff on MCO operations and policies.
• Identifies fraud, waste, and abuse in MCO environments.

Skills

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Verbal communication

Written communication

Research skills

Education

Bachelor’s degree in relevant field

6 years of experience interpreting policy

Job description

Benefits

We offer a generous benefits package.

Job Description

Catapult Consultants is hiring a Managed Care Subject Matter Expert to provide subject matter expertise and technical assistance on matters related to Managed Care operations, policies and regulations. This person will support the Data Analysis, Medical Review, Program Integrity, and Request For Information teams by consultation with staff and by participating in investigative and/or data analysis efforts.

Specific Duties

• Provides consultation and advice to staff relating to the operations, policies, guidelines and regulations of Managed Care Organizations (MCOs).
• Trains/Educates staff related to MCO operations and policies and provides continuing education updates to staff relating to the Managed Care field.
• Aides Program Integrity staff on the identification of fraud, waste and abuse in the MCO environment.
• Explains program specific procedures, guidelines and regulations to staff upon inquiry.
• Compiles and maintains various documentation and other reporting requirements.
• Communicates regularly with internal staff with appropriate written communications related to specific program information.
• Assists the Data Analysis, Program Integrity, Medical Review and Request For Information Managers and Supervisors by researching MCO coverage criteria, regulations, and policies.
• Stays current with Medicaid fraud / abuse issues and vulnerabilities and recommends appropriate proactive analysis.
• Attends meetings with external customers as necessary.
• Performs other duties as assigned by PI Management that contribute to ZPIC goals and objectives.

Qualifications

• Must be a graduate from an accredited U.S. college or university with a bachelor’s degree and/or experience equivalent to six years of professional level experience interpreting policy or procedural provisions for a health care entity.
• Must have a high proficiency level with Microsoft Word.
• Needs working knowledge of Microsoft Excel and PowerPoint.
• Should have excellent verbal and written communication skills.
• Should have excellent research skills including internet research.
• Must have the ability to work independently with minimal supervision.
• Must have the ability to perform multiple priority tasks.
• Associate must have and maintain a valid driver’s license issued by his/her state of residence.
• Must have a minimum of three years of Managed Care related experience.

EEO Statement

Catapult Consultants is an Equal Opportunity Employer. We believe that every employee has the right to work in a dignified work environment free from all forms of discrimination and harassment. It’s our policy to recruit, employ, retain, compensate, train, promote, discipline, terminate and otherwise treat all employees and job applicants based solely on qualifications, performance, and competence. This policy reflects our belief that providing equal opportunities for all employees is both our legal and moral responsibility, and good management practice. All employees and applicants are treated without regard to age, sex, color, religion, race, national origin, citizenship, veteran status, current or future military status, sexual orientation, gender identification, marital or familial status, disability or any other status protected by law.