Managed Care Operations Lead
3 weeks ago
Job Title: Managed Care Operations Lead
About Us: Hollywood Presbyterian is a leading healthcare provider in California, and we are seeking a highly skilled Managed Care Operations Lead to join our team.
About the Role: As a Managed Care Operations Lead, you will play a key role in overseeing and managing our organization's managed care operations, physician IPA/Medical Group partner relationships, and vendor management. You will work collaboratively with internal departments to research, develop, plan, and implement operational improvement initiatives that drive business success.
Key Responsibilities:
- Develop and maintain strong relationships with provider partners and management company entities.
- Participate in ongoing operations and performance meetings to ensure timely reporting and data sharing with hospital departments.
- Establish key metrics and performance dashboards for review with provider partners and hospital leadership.
- Manage a database of contracted and preferred vendors integrated with provider partner utilization management workflows.
- Interface with internal departments to ensure compliance, operational efficiencies, and effective administration of all contractual agreements and performance improvement opportunities.
- Collaborate with hospital teams and IPA/MSO partners to monitor utilization patterns, identify trends, and implement interventions to drive operational and financial success.
- Develop and maintain process documentation for managed care operations.
- Oversee execution and management of letters of agreement with non-contracted providers.
Qualifications:
Education: Bachelor's degree in business administration, health care administration, public health, or other related fields.
Experience: Minimum five (5) years of managed care experience with a health plan, provider system, or management service organization in California.
Requirements:
Estimated salary: $120,000 - $150,000 per year, depending on qualifications and experience. Benefits include medical, dental, vision, 401(k), and paid time off. We are an equal opportunity employer.
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