Senior Managed Care Ops Leader — Hybrid

UC San Diego Health; San Diego (CA); Hybrid; USD 100.000 - 143.000; Vollzeit

Zusammenfassung

UC San Diego Health seeks a Senior Managed Care Ops Specialist to research, interpret, and implement complex regulatory, contractual, and reimbursement requirements. You will act as a subject matter expert for managed care operations and provide guidance on claims administration and DOFR configurations.

The role requires advanced managed care knowledge, strong analytical skills, and the ability to translate complex requirements into practical operational solutions.

Qualifikationen

• 7 years of related experience or a Bachelor’s plus 3 years in related work.
• Thorough knowledge of managed care contracting functions and operations.
• Understanding of regulatory and contractual requirements in the managed care space.
• Strong analytical, critical-thinking, and problem-solving skills.
• Proficiency with MS Office and managed care systems.

Aufgaben

• Research, interpret, and implement complex regulatory, contractual, and reimbursement requirements.
• Serve as SME for managed care operations and guidance on claims and DOFR configurations.
• Lead cross-functional operational initiatives and identify risks.
• Develop corrective actions and support organizational modernization.
• Translate complex requirements into practical operational tasks.

Kenntnisse

Regulatory compliance

Contract negotiation

Data analysis

Cross-functional teamwork

MS Office

Communication skills

Problem solving

Ausbildung

Bachelor’s degree in related area

Tools

Epic Tapestry

Contract databases

Jobbeschreibung

UC San Diego Health seeks a Senior Managed Care Ops Specialist to research, interpret, and implement complex regulatory, contractual, and reimbursement requirements. You will act as a subject matter expert for managed care operations and provide guidance on claims administration and DOFR configurations.

The role requires advanced managed care knowledge, strong analytical skills, and the ability to translate complex requirements into practical operational solutions.