Description

The California Association of Health Facilities (CAHF) is seeking a Managed Care Policy & Reimbursement Specialist to join our dynamic policy team. This role focuses on helping long term care providers navigate the Medi-Cal managed environment The ideal candidate will be a strong communicator and relationship-builder, serving as a key liaison between CAHF members, managed care organizations, and regulatory agencies. You will analyze policy trends, gather member feedback, and help resolve reimbursement and contracting challenges—ultimately driving solutions that support our members and improve care delivery.

Requirements

We are looking for this person to:

1. Serve as a subject matter expert on managed care requirements for long term care services, including skilled nursing and developmental services providers.
2. Monitor and analyze trends in managed care policies and practices that impact long-term care providers, ensuring consistent interpretation and compliance.
3. Convene member work groups to gather feedback, share updates on managed care issues, including contracting, claims, authorizations, and payments.
4. Build and maintain relationships with the managed care community and state regulatory agencies to advocate for timely reimbursement and policy alignment.
5. Develop education resources through presentations, webinars, and member communications to improve understanding of managed care processes.
6. Support policy development and advocacy efforts by working with the reimbursement and government relations teams..

KNOWLEDGE, SKILLS AND EXPERIENCE

• Bachelor’s degree or equivalent experience in a related field.
• Excellent communication (written and verbal), problem-solving and analytical skills.
• Ability to facilitate meetings.
• Team player, collaborator, customer service oriented and strong people person.
• Self-starter needed with ability to work independently with minimum supervision.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Member-focused and customer-service oriented.

PREFERRED QUALIFICATIONS:

• Bachelor’s degree in business or equivalent policy experience in managed care.
• At least 3-5 years of experience in health care or related field.
• Experience in a nursing facility revenue cycle role.
• Working knowledge of Medi-Cal program and/or health plan contracting.
• Significant knowledge or familiarity with a variety of the field’s concepts, practices and procedures such as - delivery of health care services, claims and authorization processes, long term care reimbursement, health care program financing, understanding of managed care contracting, skilled nursing operations, and/or health plan experience.

BENEFITS: Health, dental, life, 401(k), vacation, sick leave, designated holidays, hybrid work schedule.
CONTACT: Include cover letter with resumé.