Managed Care Network Coordinator - Managed Care - FT Days

About the role

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.

Responsibilities

• Supports implementation, oversight, health plan audits, reporting, engagement, and education of the contracted provider network.
• Maintains awareness of network gaps and assists in identifying providers including those needed for one-time agreements.
• Oversees customer service and member services.
• Assists in establishing 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).
• 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.
• Able to maintain a work pace appropriate to the workload.
• Ability to establish and maintain effective working relationships across the Health System.

Qualifications

• 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.
• Able to maintain a work pace appropriate to the workload.
• Ability to establish and maintain effective working relationships across the Health System.

Skills

• Strong working knowledge of managed care concepts and medical management processes.
• Extensive knowledge of one or more managed care transaction systems.
• Excellent written and verbal communication skills.
• Demonstrated computer skills; proficient with Microsoft Windows applications.
• Advanced verbal and written communication, facilitation and presentation skills.

Benefits

Details of each benefit may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Pay

Details of pay may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Schedule

Details of schedule may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php