"Managed Care Operations Network Manager - Managed Care Operations - FT Days"

Position Summary: Incumbent supports the Population Health and Value Based Care initiatives of UCI Health with respect to provider capitation, medical group capitation and institutional capitation administration. Oversees and accountable for financial performance of primary care capitation contracts, including quality measures performance and incentives, while supporting efforts to promote risk adjustment coding initiatives. Provides support and collaboration with practice sites for performance improvement activities. In collaboration with billing, will ensure managed care contract compliance. Performs financial modeling to optimize contract reimbursement. Incumbent will also play pivotal role in configuring the business requirements for administering UCI's capitated, delegated HMO business.

What It Takes to be Successful

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.
• 3-5 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.