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Data Management Specialist (647035)
Ref No.: 18-12386
Location: Miami, Florida
Data Management Specialist
Miami FL, 33126
4+ Month Contract
 
Summary:
  • The incumbent serves a key role, responsible for the strategic and tactical direction of all development, staffing, planning, managing, and measuring the overall activities for the entire division related to every aspect of Ad hoc Provider Authorizations and Referrals, to all types of providers.
  • The position is responsible for developing and implementing national and regional plans that meet new and existing customer requirements, assures member access to qualified providers for authorized services, and collaborates with key leaders (CMC and Field Network) to maintain limits for budget plan/cost of care projections.
  • This position serves as the strategic business partner to other leadership from all areas of the organization: CMC, Network Sales, Sales, Account Management, Training, and client-wide to convey process related trends and statistical data in support of each of these departments' business strategies.
 
Essential Functions:
  • Establishes overall direction, plan, policy and procedural documentation for department to ensure compliance with corporate policies, customer requirements, reporting requirements, best practices and process efficiencies, related to requests for seeking, qualifying, and documenting and contracting out-of-network providers.
  • Ensures timely and appropriate response to all requests.
  • Responsible for development, modification, maintenance and review of Ad hoc contracts, agreements and addenda, in conjunction with Corporate Legal Counsel, in addition to Provider Authorization and Referral policy.
  • Member of project team in planning and development for processes and ACES system enhancements, and engages relevant leadership from other departments, including development and delivery of training, as necessary, (i.e. Network Field, Network Services, Account Management, IT, and Care Management centers).
  • Meet financial goals (e.g., control care cost trends, profitability) as defined by the business operations and CMC senior management team, including assuring that the out-of-network provider rates are contracted within standards.
  • Supports the development and mentoring of Department Staff in meeting objectives and functional obligations, as well as establishing plan for cross departmental job shadowing, and knowledge sharing.
  • Reviews report data and facilitates review with Field Management and CMC Leadership to identify trends and risks with plan for correction or redirection.
 
Experience:
  • 1-2 yrs. Health care administration experience (finance/contract administration, physician/provider relations, technical writing for policy & procedural) with strong preference for managed care experience.
  • Credentialing experience is a major plus.
  • The candidate will be reaching out to providers to request any credentialing documents.
 
Other:
  • Proven ability to strategically lead an organization toward the attainment of its goals and objectives, mission and values.
  • Excellent communication and negotiation skills.
  • Demonstrated team building skills to promote an environment of diversity, collaboration and recognition.
  • Computer Skills: Microsoft Office: Word, Excel and Access
 
Preferred qualifications:
  • Progressively more responsible health care administration experience (finance/contract administration, physician/provider relations, technical writing for policy & procedural) with strong preference for managed care experience.
  • Excellent organizational skills REQUIRED.
  • Must have the ability to be and work as a team member & provide support to team members as assigned.
 
Education:
  • HS/GED REQUIRED