Managed Care Network Coordinator - Managed Care - FT Days

University of California, Irvine•Orange, CA

4h•Onsite

About The Position

This position supports the Managed Care operations of UCI Health with respect to planning, development, and implementation of administrative and operational functions. The 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 identify network gaps and assist in identifying providers, including those needed for one-time agreements. The incumbent oversees customer service and member services. The 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 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.
Must be able to provide proof of work authorization.

Nice To Haves

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

Responsibilities

Supports the managed care operations of UCI Health with respect to planning, development, and implementation of administrative and operational functions.
Supports business operations for a capitated, delegated medical group serving managed care members.
Provides services including implementation, oversight, health plan audits, reporting, engagement, and education of the contracted provider network.
Monitors and identifies network gaps and assists in identifying providers, including those needed for one-time agreements.
Oversees customer service and member services.
Plays a critical role in understanding and implementing system improvement opportunities.
Establishes methods for continuous monitoring/auditing of workflows to ensure process integrity and goals, and to identify improvement opportunities.