Assistant Director, Managed Care Operations

$112,900 - $256,900/Yr

University of California - Los Angeles, CA

Full-time - Mid Level

Los Angeles, CA

Educational Services

About the position

The Assistant Director, Managed Care Operations at UCLA Health is responsible for the collaborative development, implementation, and ongoing operations of financial and administrative policies, procedures, and systems aimed at achieving the goals set by leadership for managed care contract performance. This role involves assisting the Director in integrating key managed care activities to promote effective teamwork and support high-quality operational processes.

Responsibilities

• Facilitate and provide detailed analysis, reporting, training, education, and support to leadership and the management team to promote financial success.
• Develop and maintain effective communication with key departments regarding managed care initiatives and operations, with affiliated contracted entities and with health plans.
• Ensure the Claims and System support business units are compliant with required contractual and regulatory obligations.

Requirements

• A Bachelor's degree.
• Minimum of 10 years experience in an HMO environment (i.e. MSO or IPA setting) in administration and maintenance of Provider, Fee Schedule and Benefit information in a managed care claims payment application.
• Minimum of 5 years managerial experience.
• Thorough knowledge of the delegated health care model, capitation, and other managed care IPA and provider reimbursement methodologies.
• Skill in contract interpretation and benefit interpretation.
• In-depth knowledge of CPT-4, ICD-10, and HCPCS codes.
• Proficient computer skills including Internet search capabilities, Microsoft Word, Excel, and Access.
• Extensive understanding of Managed Care systems (i.e. EZ Cap, Diamond, Tapestry, IDX) including the flow of information and the impact to operations.
• Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines.
• Skill in analyzing information, problems, and procedures to define the problem, identify relevant factors, identify patterns and relationships, formulate logical and objective conclusions, and recognize alternatives.

Nice-to-haves

• Ability to travel locally and overnight as required.