Los Angeles, California
Pasadena, California
Durham, North Carolina
Durham, North Carolina
Durham, North Carolina
Posted: 08-Sep-24
Location: Los Angeles, California
Salary: Open
Categories:
Internal Number: 142197742
The Assistant Director, Managed Care Operations is responsible for the collaborative development, implementation and ongoing operations of financial and administrative policies, procedures and systems to achieve the goals set by leadership for UCLA Medical Group managed care contract performance.
In this role, you will assist the Director, Managed Care Operations in ensuring the integration of key managed care activities to promote effective teamwork to efficiently support the achievement of cost-effective, high quality operational processes.
Primary responsibilities include, but are not limited to, the following:
- facilitate and provide detailed analysis, reporting, training, education and support to leadership and the management team to promote financial success
- develop and maintain effective communication with key departments regarding managed care initiatives and operations, with affiliated contracted entities and with health plans
- ensure the Claims and System support business units are compliant with required contractual and regulatory obligations
This is a flex-hybrid role which will require you to be onsite as required by operational need; there are no reimbursements for travel to "home office" location. Each employee must complete a FlexWork Agreement with their manager which will outline arrangement parameters and aids both parties in fully understanding expectations. Arrangements are regularly evaluated, and are subject to termination.
We are seeking a dynamic leader with:
• A Bachelor’s degree
• Minimum of 10 years experience in an HMO environment (i.e. MSO or IPA setting) in administration and maintenance of Provider, Fee Schedule and Benefit information in a managed care claims payment application
• Minimum of 5 years managerial experience
• Thorough knowledge of the delegated health care model, capitation and other managed care IPA and provider reimbursement methodologies
• Skill in contract interpretation and benefit interpretation
• In-depth knowledge of CPT-4, ICD-10, and HCPCS codes
• Proficient computer skills including Internet search capabilities, Microsoft Word, Excel and Access
• Extensive understanding of Managed Care systems (i.e. EZ Cap, Diamond, Tapestry, IDX) including the flow of information and the impact to operations
• Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines
• Skill in analyzing information, problems and procedures to define the problem, identify relevant factors, identify patterns and relationships, formulate logical and objective conclusions and recognize alternative
• Ability to travel locally and overnight as required
