"Managed Care Operations Claim Manager - Managed Care Operations - FT"

Managed Care Operations Claim Manager - Managed Care Operations - FT

Req ID: 100544

Location: Anaheim, California

Division: Medical Center

Department: Managed Care Operations

Position Type: Full Time

Salary Range Minimum: USD $108,100.00/Yr.

Salary Range Maximum: USD $204,900.00/Yr.

Who We Are

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America's Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County's only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

To learn more about UCI Health, visit www.ucihealth.org.

Your Role on the Team

Position Summary:

Incumbent supports Managed Care Claims at UCI Health with respect to overseeing the daily operations of department. Oversees and accountable for performance, planning, development, implementing, staff oversight, and training both internally and externally with stakeholders. Incumbent is responsible for ensuring that quality levels of performance are maintained throughout the Claims Department and that all functions remain in compliance with payor requirements and as well as State and Federal regulations. Accountable for new provider contract implementations and/or system implementations. Incumbent must maintain an up-to date knowledge of national and state-wide standards and regulations pertaining to claims processes for a capitated, delegated medical group with HMO healthplan contracts.

What It Takes to be Successful

Total Compensation

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Required Qualifications:

• Superior managerial skills and ability to create and direct a high-performing team.
• Strategic problem-solving skills to evaluate complex or new issues and identify options for resolution when no precedent exists. Demonstrated analytical skills to probe, challenge, and to question the status quo.
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties.
• Must demonstrate customer service skills appropriate to the job.
• Knowledge of various managed care payment methodologies, including performance-based compensation (quality, coding, patient experience, etc).
• Interpersonal skills to maintain professional relationships with managed care organizations, peers, senior management, and assigned staff. Ability to work collaboratively and promote others, soliciting and incorporating their ideas when appropriate. Demonstrated quality customer service skills with all constituencies.
• Excellent written and verbal communication skills in English.
• Demonstrated strong conflict resolution skills.
• Demonstrated ability to accomplish results and achieve organizational goals.
• Bachelor's degree in business related field, or an equivalent combination of education and/or experience.
• Advanced verbal and written communication, facilitation and presentation skills including the ability to positively interact with executives, providers, and staff at all levels.
• Advanced skills to organize, simplify and increase efficiency of Managed Care processes and procedures. Ability to create and maintain a climate of teamwork and collaboration across departments, effective problem solving and conflict resolution.
• Advanced knowledge of relevant Managed Care industry laws, regulations and business / industry trends. Ability to apply policy knowledge to proactively identify potential risk areas.
• Ability to maintain a work pace appropriate to the workload.
• Ability to establish and maintain effective working relationships across the Health System.
• 5 years of relevant managed care (commercial, MediCal and MA) experience in an IPA, MSO, or large delegated medical group setting.

Preferred Qualifications:

• Previous experience working in an academic medical setting.
• Knowledge of University and medical center organizations, policies, procedures and forms.
• Knowledge of EZ Cap.
• Familiarity with Managed Care and practice management applications / systems. Knowledge of other computer programs in the industry and ability to notice technological inefficiencies and analyze pros and cons of adopting alternatives.
• Advanced degree in related field.