Senior Managed Care Ops Specialist - Hybrid - 141676

Payroll Title MGD CARE SPEC 3 Department PHSO - MSO Hiring Pay Scale $100,000 - $143,000 / Year Worksite Greenwich Drive Appointment Type Career Appointment Percent 100% Union Uncovered Total Openings 1 Work Schedule Days, 8-Hour Shifts, Monday - Friday #141676 Senior Managed Care Ops Specialist - Hybrid Filing Deadline: Mon 10/12/2026 Apply Now UC San Diego values and welcomes people from all backgrounds. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply. UCSD Layoff from Career Appointment: Apply by 10/08/26 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Reassignment Applicants: Eligible Reassignment clients should contact their Disability Counselor for assistance. This is a UC San Diego Internal Recruitment open to UCSD and UCSD Health System Staff Only. Description This position serves as a senior operational resource responsible for researching, interpreting, and implementing complex regulatory, contractual, benefit, and reimbursement requirements. The incumbent acts as a subject matter expert for managed care operations and provides guidance on complex issues involving claims administration, DOFR arrangements, benefit administration, and system configuration. The position is expected to operate with a high degree of autonomy, lead cross-functional operational initiatives, identify emerging risks, develop corrective actions, and support organizational modernization efforts. Success in this role requires advanced managed care knowledge, strong analytical skills, and the ability to translate complex requirements into practical operational solutions. Minimum Qualifications Seven (7) years of related experience, education/training, OR a Bachelor’s degree in related area plus three (3) years of related experience/training. Related experience: configuring DOFR logic within Epic Tapestry. Interpreting contractual and regulatory requirements and translating the requirements into operational tasks. Thorough knowledge of all managed care contracting functions, and daily operations, including negotiation, implementation, execution, tracking, and maintaining of contracts. Understanding of the industry's best practices. Ability to conduct market research and analysis. Knowledge of relevant health system and UC policies and processes. Thorough knowledge of relevant federal, state, and local laws and regulations to identify potential compliance risks. Strong analysis skills to perform critical analysis of contract financial performance. Strong interpersonal and customer service skills, with the ability to cultivate and maintain constructive working relationships with both internal and external constituencies. Proven analytical, critical-thinking, and problem-solving skills, with the ability to assess complex problems, respond effectively to questions and concerns, and identify and present potential solutions. Strong detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts. Highly proficient with MS Office (Word, Excel, PowerPoint, Outlook),specialized contract databases and managed care systems. Preferred Qualifications Experience configuring DOFR logic in Epic Tapestry. UCSD managed care operations.Experience with regulatory and contractual requirements of the managed care industry. SPECIAL CONDITIONS Must be able to work various hours and locations based on business needs.Employment is subject to a criminal background check and pre-employment physical. Pay Transparency Act Annual Full Pay Range: $100,100 - $187,500 (will be prorated if the appointment percentage is less than 100%) Hourly Equivalent: $47.94 - $89.80 Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable). Apply Now If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements. If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable. UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team! Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached. To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community. The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information. UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening. Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. "Misconduct" means any violation of the policies governing employee conduct at the applicant’s previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC’s policies addressing some forms of misconduct:UC Sexual Violence and Sexual Harassment PolicyUC Anti-Discrimination PolicyAbusive Conduct in the Workplace