The Managed Care Director is responsible for having an understanding of the differing counties managed care plans, processes, and anticipated changes and to be able to interpret the impact or develop the best way for the health center to incorporate those changes into the organization effectively and efficiently. This position is also responsible for the development, documentation, and communication of internal systems and infrastructure to facilitate the transition and/or implementation. The Managed Care Director is responsible to ensure that United Health Centers’ participation in Managed Care meets UHC’s patient satisfaction, regulatory adherence, and financial standards for the health centers. This position reports to the Chief Financial Officer (CFO).
Summary of Responsibilities:
Works to establish policies and procedures to assist UHC in maximizing contract provisions with health plans.
Effectively communicates changes regarding contracted health plans for claims processing, data management and information systems, financial management, eligibility verification, specialty panel access, patient tracking provider relations, patient satisfaction and health education to staff.
Assess and determines the overall organizational viability of managed care contracts.
Assist the CFO in the development and maintenance of prudent accounting and financial policies and procedures for the UHC Managed Care Program.
Maintains an active awareness of County and agency opportunities that can help to strengthen business opportunities for UHC.
Works to foster an environment that promotes UHC’s Quality Improvement Program.
Bachelor’s degree in Business or Health Administration or related field.
Possess a valid CA Driver’s License
Two (2) or more years of experience in a managed care healthcare setting, preferably in an ambulatory care environment.
Comfortable understanding of code sets (e.g., ICD-9, CPT, CDT, etc.).
Understanding and experience in contract negotiations.
Clear working knowledge of State and Federal regulations regarding managed care and Knox-Keene Health Plan Services Act.
Communication Skills which include ability to draft corporate documents, procedural guides, technical writing, and agreement/MOU writing.
Able to quickly build and maintain rapport with patients and providers of differing backgrounds; team player.
Meeting facilitation and curriculum development skills that include understanding of adult learning and general training techniques.
About United Health Centers of the San Joaquin Valley
United Health Centers has been providing quality health care to residents of Fresno, Tulare, and Kings Counties for over 30 years. We are a not-for-profit federally-qualified health center organization established in 1971 by a group of community members dedicated to improving the overall health of the families located in the rural central valley area. Approximately a 3-hour one-way drive to the ...Central Coast of California and a 1-hour drive to the Yosemite National Park and Kings Canyon National Park. Fresno, Tulare, and Kings Counties are in the heart of California and is an agriculturally rich area which produces a variety of crops.