Managed Care Network Coordinator - Managed Care Operations - FT Days

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 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 :

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. Services include implementation, oversight, health plan audits, reporting, engagement, and education of the contracted provider network. The incumbent will monitor and identified network gaps and assist in identifying providers including those needed for one-time agreements. Incumbent oversees customer service and member services. Incumbent plays a critical role in understanding and implementing system improvement opportunities. The incumbent will establish 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.

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 :

• 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)
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• 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.
• Ability to maintain a work pace appropriate to the workload
• Ability to establish and maintain effective working relationships across the Health System

Preferred Qualifications :

Conditions of Employment :

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment :

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

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

Closing Statement :

The University of California, Irvine is an Equal Opportunity / Affirmative Action 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 categories covered by the UC nondiscrimination policy .

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8 : 30 a.m. - 5 : 00 p.m.

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization