Senior Managed Care Ops Specialist - Hybrid - 141676

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

Job summary

UC San Diego seeks a senior operational resource to research and implement complex regulatory and contractual requirements in managed care. You will guide claims administration, DOFR arrangements, and system configuration with autonomy and cross-functional leadership.

Successful candidates have advanced knowledge of managed care contracting, strong analytical skills, and the ability to translate regulatory needs into practical operational actions within a changing health system.

Qualifications

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training.
• Thorough knowledge of all managed care contracting functions, and daily operations, including negotiation, implementation, execution, tracking, and maintaining of contracts.
• Understanding of the industry's best practices. Ability to conduct market research and analysis.
• Knowledge of relevant health system and UC policies and processes. Thorough knowledge of relevant federal, state, and local laws and regulations to identify potential compliance risks.
• Strong analysis skills to perform critical analysis of contract financial performance.
• Strong interpersonal and customer service skills, with the ability to cultivate and maintain constructive working relationships with both internal and external constituencies.
• Proven analytical, critical-thinking, and problem-solving skills, with the ability to assess complex problems, respond effectively to questions and concerns, and identify and present potential solutions.
• Strong detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts.
• Highly proficient with MS Office (Word, Excel, PowerPoint, Outlook), specialized contract databases and managed care systems.

Responsibilities

• Research, interpret, and implement complex regulatory, contractual, benefit, and reimbursement requirements.
• Act as a subject matter expert for managed care operations and advise on complex issues involving claims administration, DOFR arrangements, benefit administration, and system configuration.
• Lead cross-functional operational initiatives, identify emerging risks, develop corrective actions, and support organizational modernization efforts.
• Translate complex requirements into practical operational solutions with a high degree of autonomy.

Skills

Regulatory knowledge

Contracting expertise

Data analysis

Stakeholder management

MS Office

Epic Tapestry

Education

Bachelor's degree in related area

Tools

Epic Tapestry

MS Office Suite

Job description

UCSD Layoff from Career Appointment: Apply by 10/08/26 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Reassignment Applicants: Eligible Reassignment clients should contact their Disability Counselor for assistance.

This is a UC San Diego Internal Recruitment open to UCSD and UCSD Health System Staff Only.

DESCRIPTION

This position serves as a senior operational resource responsible for researching, interpreting, and implementing complex regulatory, contractual, benefit, and reimbursement requirements. The incumbent acts as a subject matter expert for managed care operations and provides guidance on complex issues involving claims administration, DOFR arrangements, benefit administration, and system configuration. The position is expected to operate with a high degree of autonomy, lead cross-functional operational initiatives, identify emerging risks, develop corrective actions, and support organizational modernization efforts. Success in this role requires advanced managed care knowledge, strong analytical skills, and the ability to translate complex requirements into practical operational solutions.

MINIMUM QUALIFICATIONS

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training. Related experience: configuring DOFR logic within Epic Tapestry. Interpreting contractual and regulatory requirements and translating the requirements into operational tasks.
• Thorough knowledge of all managed care contracting functions, and daily operations, including negotiation, implementation, execution, tracking, and maintaining of contracts.
• Understanding of the industry's best practices. Ability to conduct market research and analysis.
• Knowledge of relevant health system and UC policies and processes. Thorough knowledge of relevant federal, state, and local laws and regulations to identify potential compliance risks.
• Strong analysis skills to perform critical analysis of contract financial performance.
• Strong interpersonal and customer service skills, with the ability to cultivate and maintain constructive working relationships with both internal and external constituencies.
• Proven analytical, critical-thinking, and problem-solving skills, with the ability to assess complex problems, respond effectively to questions and concerns, and identify and present potential solutions.
• Strong detail orientation, organizational and project management skills to negotiate, manage, and track complex managed care contracts.
• Highly proficient with MS Office (Word, Excel, PowerPoint, Outlook), specialized contract databases and managed care systems.

PREFERRED QUALIFICATIONS

• Experience configuring DOFR logic in Epic Tapestry.
• UCSD managed care operations.
• Experience with regulatory and contractual requirements of the managed care industry.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: $100,100 - $187,500 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $47.94 - $89.80

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).