Senior Managed Care Operations Strategist

UC San Diego Health; San Diego (CA); On-site; USD 100,000 - 188,000; Full time

Job summary

UC San Diego Health is seeking a senior operational resource responsible for researching, interpreting, and implementing complex regulatory, contractual, benefit, and reimbursement requirements within managed care.

The incumbent acts as a subject matter expert for operations and provides guidance on complex issues involving claims administration, DOFR arrangements, benefit administration, and system configuration.

Qualifications

• Seven+ years of related experience or a Bachelor's degree in related area plus three years of related experience/training.
• Thorough knowledge of managed care contracting functions and daily operations.
• Understanding of the industry's best practices. Ability to conduct market research and analysis.

Responsibilities

• Research, interpret, and implement complex regulatory and contractual requirements.
• Act as subject matter expert for managed care operations and guidance on claims, DOFR, benefits, and system configuration.
• Translate complex requirements into practical operational tasks and solutions.
• Identify emerging risks, develop corrective actions, and support organizational modernization efforts.

Skills

Regulatory compliance

Contract negotiations

Data analysis

Communication

Education

Bachelor's degree in related field

Tools

Epic Tapestry

MS Office

Job description

UC San Diego Health is seeking a senior operational resource responsible for researching, interpreting, and implementing complex regulatory, contractual, benefit, and reimbursement requirements within managed care.

The incumbent acts as a subject matter expert for operations and provides guidance on complex issues involving claims administration, DOFR arrangements, benefit administration, and system configuration.