Managed Care Manager

Family HealthCare Network•Visalia, CA

7h•$85,659 - $128,488

About The Position

The Managed Care Manager leads departmental staff and oversees the development, management, and implementation of managed care activities and initiatives. The role serves as the primary point of contact for health plans and coordinates audits, meetings, quality improvement initiatives, customized reporting, contract monitoring, and analysis of clinical and operating costs. It develops policies and procedures to help the network meet health plan requirements, maximize contract provisions and incentives, and track progress toward organizational goals. The position coordinates health center site enrollments across Medi-Cal, Medicare, commercial insurance, and specified programs, and maintains Optometry and Dental site enrollments with contracted plans. It produces, validates, and interprets health plan membership and payer revenue data; monitors payer profitability; and maintains compliance data. The manager also supports Accountable Care Organization initiatives, provider hospital privileges and payer enrollment, and accurate provider rosters. The role works with billing and finance on provider effective dates and keeps credentialing and enrollment processes aligned with payer and regulatory requirements. The position requires effective written and verbal communication, the ability to resolve conflicts, and the ability to communicate technical information to non-technical audiences. Employees must be able to work at any FHCN location based on business needs and adhere to the attendance policy. Effective June 1, 2026, newly hired individuals must meet the stated education, experience, and minimum credit-score requirements.

Requirements

Bachelor’s degree with a recognized major and a minimum cumulative GPA of 2.5, effective June 1, 2026; the stated provision allows proof of GPA from a higher-level degree in lieu of a high school diploma or associate degree when applicable.
Minimum of four years of leadership experience, or five years of progressively greater responsibility or significant contributions to projects and initiatives demonstrating leadership skills.
Minimum of two years of experience in a managed care environment, emphasizing financial management in an IPA or HMO setting.
Minimum credit score of 650, effective June 1, 2026.
Proficiency in written and verbal communication, basic mathematics, computer applications, and technical systems.
Ability to communicate opinions and synthesized or analyzed information effectively in writing and verbally.
Ability to resolve conflicts involving employees, customers or clients, the public, legal entities, or governmental authorities.
Ability to compile, analyze, and prepare information in written forms such as correspondence, reports, articles, or other documentation.
Ability to convey technical information to non-technical audiences.
Regular attendance is an essential function; ability to work at any FHCN location based on business need.
Ability to sit and perform repetitive hand movements for typing and grasping; frequently stand or walk; occasionally lift or move up to 20 pounds.

Responsibilities

Supervise departmental staff, including hiring and promotion recommendations, performance management, coaching, training, daily work direction, staffing monitoring, and performance feedback.
Ensure staff follow company workflows, procedures, policies, and training plans; correct noncompliance and report recurring offenses as needed.
Recommend workflow and procedure changes, assist with keeping department expenses within budget, and maintain employee-related reporting and tracking.
Serve as the main point of contact for health plans and coordinate health plan audits, meetings, and quality improvement initiatives.
Coordinate development of customized health plan reports covering financial, demographic, medical, and utilization data.
Monitor contract financial status and recommend amendments or changes to reduce organizational financial, legal, and operational risks.
Assist in analyzing clinical and operating costs to maximize system efficiencies.
Identify and facilitate managed care training needs for health center staff.
Establish a patient recall campaign calendar and coordinate recall campaigns.
Develop policies and procedures to help the network meet health plan requirements and maximize contract provisions and incentives; publish reports tracking incentive goals.
Coordinate FHCN site enrollments in Medi-Cal, Medicare, commercial insurance, and programs such as FPACT, Every Woman Counts, and CHDP; maintain Optometry and Dental site enrollments with contracted plans.
Produce, validate, and interpret health plan membership reports and internal status reports; define data requirements, investigate discrepancies, monitor payer revenue and profitability, and maintain the Compliance Data Base for health plans and special projects.
Manage ACO initiatives with the ACO administrative organization and facilitate communication across departments to support ACO quality and cost goals.
Work with billing and finance to ensure effective dates for providers with health plans and programs are correct.
Review and submit initial and reappointment provider hospital privilege applications and ensure privileges remain current.
Oversee timely provider enrollment with health plans, IPAs, and other payors, maintain accurate provider rosters, review applications and documentation, resolve deficiencies, and submit required payer enrollment materials and audits.
Communicate provider credentialing and status-change notifications to third-party payers; monitor payer and regulatory requirements and recommend updates to credentialing policies, procedures, workflows, and work instructions.
Adhere to the Attendance and Absenteeism Policy and be able to work at any FHCN location based on business need.
Perform other duties as assigned.