Managed Care Network Coordinator - Managed Care - 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 comprises its main campus, UCI Medical Center, a 459-bed acute care hospital in Orange, CA, four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties, and ambulatory care centers across the region. 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 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 identify 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 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 EPIC (Tapestry Module), EZ Cap, etc Excellent written and verbal communication skills in English Demonstrated computer skills; proficient with Microsoft Windows applications including 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: Previous experience working in an academic medical setting Knowledge of University and medical center organizations, policies, procedures and forms Knowledge of University and Medical Center organizations, policies, procedures and forms Total Rewards 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. 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: Background Check and Live Scan Employment Misconduct* Legal Right to Work in the United States Vaccination Policies Smoking and Tobacco Policy Drug Free Environment Exercise the utmost discretion in managing sensitive information learned in the course of performing duties. Sensitive information includes employee and student records, health and patient records, financial data, strategic plans, proprietary information, and any other sensitive or non-public information learned during the course and scope of employment. Ensure that sensitive information is properly safeguarded and follow all organizational policies and laws on data protection and privacy. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional 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 misconduct, or are currently the subject of any administrative or disciplinary proceedings involving misconduct. The following additional conditions may apply, depending on business unit or job-specific requirements: California Child Abuse and Neglect Reporting Act E-Verify Pre-Placement Health Evaluation Details of each policy may be reviewed at the following page: Closing Statement: 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 categories covered by the UC Anti-Discrimination Policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI’s Employee Experience Center (EEC) at View email address on click.appcast.io or View phone number on click.appcast.io, 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 #J-18808-Ljbffr