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

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:

• 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 their duties. Sensitive information includes but is not limited to 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. Understands that sensitive information should be shared on a limited basis and actively takes steps to limit access to sensitive information to individuals who have legitimate business need to know. Ensure that sensitive information is properly safeguarded. Follow all organizational policies and laws on data protection and privacy. This includes secure handling of physical and digital records and proper usage of IT systems to prevent data leaks. The unauthorized or improper disclosure of confidential work-related information obtained from any source on any work-related matter is a violation of these expectations.

*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 that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon 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 by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization