Torrance Memorial Health System is currently accepting applications for
a Managed Care Specialist to join our team. Under the direction of the
Vice President of Managed Care and Decision Support Manager, this position
provides administrative support to the Managed Care Department.
Primary Duties and Responsibilities:
- Management of contract files. Responsible for the filing and distribution
of new contracts and contract amendments to health plans and affected
internal departments. Also responsible for tracking of contract documents
as they flow through the contract approval and signature process.
- Responsible for maintaining the Managed Care Department’s contract
renewal calendar, contacts list, and consolidated rate summary for all
health plan agreements for TMMC, THIPA, TMPN, THH, and TSC.
- Follows up on credentialing requests and helps assemble and distribute
other documents as needed. Supports Decision Support Manager with obtaining
and distribution of rate schedules and applicable fee schedule for loading
(NThrive, Cymetrix & AMM).
- Assists the Vice President of Managed Care with the negotiation of patient-specific
letters of agreement (LOAs) with health plans that are not contracted
with Torrance Memorial Medical Center.
- Acts as a hospital liaison to health plans and medical groups to address
and resolve ongoing operational and contract administration issues related
to managed care contracts. Works with medical group’s referral and
Utilization Management staff, as appropriate, to address issues related
to member benefits, provider service issues, authorization and U.R. requirements,
communication mechanisms and system issues. Assists Decision Support Manager
with assessment and tracking of contract loads into NThrive.
- Performs basic clerical and general office duties such as receiving visitors,
answering and screening telephone calls, typing correspondence, filing,
retrieving and distributing mail.
- Types correspondence and provides project support, coordinates meetings,
prepares agendas, minutes, and lists of follow up action items.
Coordinates facilities and general office support.
- Coordinates facility maintenance requests – interfacing with external
vendors and property manager as needed.
- Ensures that supplies are managed.
- Maintains an organized and orderly environment.
- Coordinates with HR for personnel security/badge access.
- Conducts supervised research, and works on specific contracting and marketing
projects as needed.
- Demonstrates behaviors that are consistent with the values of service,
excellence, knowledge, stability and community. Demonstrates good customer
- Ensures that privacy and confidentially rules are followed in accordance
with the Health System, State, Federal and HIPAA regulations.