The Managed Care Liaison will serve as a Liaison between the Stony Brook Department of Managed Care, the Stony Brook Clinical Practice Management Plan (CPMP) and the payers.
Duties of the Managed Care Liaison may include the following but are not limited to:
Maintain familiarity with all Managed Care contacts, terms and conditions, including reimbursement provisions between SBM and health plan and payers.
Develop and maintain networks of contract with Managed Care companies and all departments of SBM.
Analyze regular and special health plan/payer communications and correspondence respecting their policies and procedures and changes and updates thereto, and communicate the same to relevant SBM representatives. Where a communication contains a significant material change in SBM practices, identify the same with specificity.
Act as a resource for referrals from Managed Care colleagues; intervene in and resolve specific issues or problems related to SBM contracts, claims adjudication and correct payment; enrollment of clinical providers; and authorization and referral difficulties.
Other duties as assigned.
Required Qualifications: Master's degree. Minimum of three (3) years' experience with a major Managed Care organization; tertiary care hospital or major physician practice group, with one (1) year of such experience in a Managed Care setting. The candidate must demonstrate competent problem-solving skills and be adept in interpersonal communications. The candidate must be able to work cooperatively with other staff as well as independently, and effectively manage multiple assignments and priorities. Experience with Rapid Improvement Events, Pay for Performance Improvement, Lean and Managed Care. Six Sigma Certified. Proficient in the development and interpretation of data spreadsheet processes (such as Excel) and in Microsoft programs. Demonstrable background in healthcare policy and management.
Special Notes: The Search Committee will begin the review of applications on 03/20/2019 and continue until the position is filled.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions are subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
About Stony Brook Medicine:
The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients' lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island's premier academic medical center. With 603 beds, we serve as the region's only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children's Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County's only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation's first Pediatric Multiple Sclerosis Center.
Stony Brook University is an Affirmative Action/Equal Opportunity employer. We are committed to the creation of a diverse and inclusive campus climate. We encourage protected veterans, individuals with disabilities, women and minorities to apply.
This function/position has been designated as
Internal Number: 1900797
About Stony Brook University
FROM ITS BEGINNINGS A HALF-CENTURY AGO, STONY BROOK UNIVERSITY HAS BEEN CHARACTERIZED by innovation, energy and progress, transforming the lives of people who earn degrees, work and make groundbreaking discoveries here. A dramatic trajectory of growth has turned what was once a small teacher preparation college into an internationally recognized research institution that is changing the world.