Managed Care Network Coordinator - Managed Care Operations - FT Days

University of California System•Anaheim, CA

27d

About The Position

Position supports the Managed Care operations of UCI Health with respect to planning, development and implementation of administrative and operational functions. Incumbent supports the various business operations needed to operate a capitated, delegated medical group providing service to managed care members. Services include implementation, oversight, health plan audits, reporting, engagement, and education of the contracted provider network. The incumbent will monitor and identified network gaps and assist in identifying providers including those needed for one-time agreements. Incumbent oversees customer service and member services. Incumbent plays a critical role in understanding and implementing system improvement opportunities. The incumbent will establish methods for continuous monitoring/auditing of workflows to ensure the integrity and goals of the processes remain consistent and to identify potential opportunities for improvement.

Requirements

Strong working knowledge of managed care concepts and medical management processes, including medical terminology, insurance benefit plans, and claims and medical coding (CPT, ICD-9/ICD-10 and HCPC)
Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
Must demonstrate customer service skills appropriate to the job
Minimum of five (5) years previous experience in Provider Relations specifically related to managed care in a complex and diversified healthcare or health insurance company
Extensive knowledge of one or more managed care transaction systems such as the following: EPIC (Tapestry Module), EZ Cap, etc
Excellent written and verbal communication skills in English
Demonstrated computer skills; proficient with Microsoft Windows applications including but not limited to Excel, Word and Outlook as well as ability to conduct research with health plans and insurance products.
Bachelor's Degree in Healthcare Administration, Business Administration or a related field, or an equivalent combination of education and experience
Advanced verbal and written communication, facilitation and presentation skills including the ability to positively interact with executives, providers, and staff at all levels.
Ability to maintain a work pace appropriate to the workload
Ability to establish and maintain effective working relationships across the Health System

Nice To Haves

Previous experience working in an academic medical setting
Knowledge of University and medical center organizations, policies, procedures and forms
Knowledge of University and Medical Center organizations, policies, procedures and forms