Managed Care Coordinator

CHOC Children's; Orange (CA); On-site; USD 64,000 - 106,000; Full time

Job summary

CHOC Children's in Orange, California seeks a Managed Care Coordinator to review, analyze and implement managed care contracts and products, and to organize educational forums for staff. This role requires leadership to coordinate cross-functional teams and ensure smooth contract operations.

The position emphasizes strong communication, knowledge of payer structures, and the ability to drive operational improvements within a hospital setting, with day shift responsibilities and a competitive pay

Qualifications

• Minimum two years of managed care or provider relations experience in the healthcare field.
• Excellent oral and written communication; proficient in Word, Excel and PowerPoint.
• Knowledge of HMO/POS/PPO and Medi-Cal payor structures.

Responsibilities

• Assist in review, analysis and implementation of managed care contracts and products.
• Organize and conduct managed care educational forums.
• Lead interdepartmental teams to operationalize contracts and resolve issues.
• Participate in development of operations support systems for managed care.

Skills

Communication skills

Word

Excel

PowerPoint

Managed care knowledge

Education

High School Diploma

Bachelor's degree

Tools

Access

Job description

Why CHOC?

At CHOC, we strive to be the leading destination of children’s health by providing exceptional and innovative care. We are responsible for the overall health of our community’s pediatric population in our hospitals, clinics, and practices. And because of our breadth of care, your career at CHOC can be as diverse and fulfilling as you determine. CHOC’s compensation structure, benefits offerings, and career development programs are geared to helping you achieve your professional and personal goals.

Work Location

Orange, California

Work Shift

Day – 08hrs (United States of America)

Environmental Sustainability Statement

Driven by the connection between children's health and a healthy environment, we commit to creating a healthcare model that incorporates environmental sustainability aligned with our mission to protect children's health and patient safety.

Job Summary

The Managed Care Coordinator assists with the review, analysis and implementation of managed care contracts and products, organizes and implements managed care educational forums. Leads interdepartmental teams in operationalizing managed care contracts and resolving identified managed care operational issues; participates in the development of managed care operations support systems.

Pay Range

Minimum $64,355 Midpoint $85,259 Maximum $106,184

Rate of pay is determined by various factors, including but not limited to knowledge, skills, competencies, experience, education, as well as position requirements.

Experience

• Required: Minimum two (2) years of managed care or provider relations experience in the healthcare field.
• Preferred: Three (3) or more years managed care contract administration experience in a hospital setting or health plan.

Education

• Required: High School Diploma/ GED or equivalent experience.
• Preferred: Bachelor's degree in Healthcare Administration, Business Administration or closely related field.

Specialized Skills

• Required: Excellent oral and written communication skills. Proficient in Word, Excel and PowerPoint. Knowledge of managed care HMO/POS/PPO and Medi-Cal payor structures.
• Preferred: Excellent oral and written communication skills, to include presenting to groups. Proficient in Word, Excel,PowerPoint and Access. Thorough Knowledge and operational experience with commercial and governmental health services payor resources, managed care strategies and basic finance/budget principles.

Licensure

• Required: None Required

Work Environments - Functional Demand

Sedentary - Very light energy level Lift 10 lbs. box overhead. Lift and carry 15 lbs. Push/pull 20 lbs. cart.

Physical Activity Requirements

Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation

Physical Activity Lifting

Lifting (Floor to waist level) - Constant 67 or more%, Lifting (Floor to waist level) - Frequent 36-66%, Lifting (Floor to waist level) - Occasional 0-35%, Lifting (Waist level and above) - Constant 67 or more%, Lifting (Waist level and above) - Frequent 36-66%, Lifting (Waist level and above) - Occasional 0-35%

Sensory Requirements

Color Discrimination, Depth Perception, Far Vision, Hearing, Near Vision

Environment Requirements

Airborn Communicable Disease, Bloodborne Pathogens, Chemical, Dust Particular Matter, Extreme Noise Levels, Extreme Temperatures, Radiation, Uneven Surfaces or Elevations

Non-Discrimination Statement

CHOC does not discriminate on the basis of age, race, color, religion, national origin, ancestry, marital status, genetic information, disability, sex, gender (including pregnancy, breastfeeding, childbirth, lactation or related medical conditions), gender identity or expression, medical condition, sexual orientation, veteran status, military or uniformed service member status, or other protected characteristics in accordance with state and federal laws.

We encourage individuals from all backgrounds to apply for positions at CHOC, even if your experience doesn’t align perfectly with the listed qualifications for a particular role, as your unique experience may be a great addition to our culture for another one of our opportunities.

If you desire support or accommodations throughout the Talent Acquisition process, please inform your Talent Acquisition Partner.