Medicare Specialist
Universal Health Care - Saint Petersburg, FL

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Under direct supervision of the Sr. Manager of Quality will assist with management of Medicare Quality Management projects. Such projects may cover aspects of Universal’s strategic plan or regulatory obligations, including improving member retention and operational improvements. The Specialist must be able to work independently to identify opportunities for operational improvement. Strong analytical and process-oriented thinking skills are required, as the Specialist must provide technical support for converting moderately complex data and health policy problems into solutions.

Position Responsibilities:
  • Collect, organize and analyze data from government and organization’s various systems and compile the information into meaningful reports and facts that can be used by management to make decisions on the Medicare products;
  • Communicates, prepares and delivers required reports and Quality Management requirements to outside government agencies; Work closely with internal and external partners to produce and supply information necessary to the business units and Medicare beneficiaries;
  • Work closely with internal partners to ensure Medicare strategic initiatives are implemented, tracked and reported successfully;
  • Develops well-organized, documented, and maintained data files;
  • Develops awareness of and familiarity with issues and events affecting the plan’s members and providers;
  • Update Management and other Associates on operational issues, process changes and activity status, that relate to Medicare;
  • Continuously, improves quality and information value of products and services developed for the plan;
  • Assist functional areas with Medicare related inquiries;
  • Understands and keeps current of changes in Medicare at the local, state, and federal level;
  • Ensure compliance is met and adhered to with all Medicare Quality Management related items;
  • Responsible for meeting departmental and individual performance goals;
  • Other duties as assigned
Skill Requirements and Preferences:
  • Extensive knowledge Managed Care Organizations
  • Project management skills
  • Experience with the systematic consolidation of data and regulatory reporting
  • Excellent communication skills, must be able to effectively communicate, orally and written, to all constituents up and down the organizational chart
  • Ability to work autonomously, as well as successfully cooperate within a team environment
  • Strong attention to detail
  • Problem solving and analytical acumen
Educational Requirements and Experience:
  • Bachelor’s degree in related field preferred
  • 5 -7 years managed care experience required; Medicare HMO preferred;
  • Knowledge of Quality Management requirements preferred

Universal Health Care - 2 years ago - save job