Managed Care Operations Manager

U Mass Memorial Health
US - Massachusetts - Worcester
January 5, 2025

Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.

Exemption Status:

Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8:
30AM - 5:
00PM

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

Cost Center:

99940 - 5876 Payer Contracting

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities.
Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve.
We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other.
And everyone, in their own unique way, plays an important part, every day.

Major Responsibilities:

Responsible for resolution of operational issues impacting claims payment, including billing, patient registration, referral and authorization, credentialing, and provider set up issues.
Works with internal and external customers to improve workflow and resolve payment discrepancies.
Researches UMMHC contractual requirements and operational policies to ensure health plan compliance with negotiated financial arrangements.
Coordinates efforts with management within Contracting and Provider Relations.
Provides effective direction, guidance, and leadership in conducting monthly claims meetings and fosters effective teamwork in problem resolution.
Coordinates the assignment of tasks and helps resolve technical and operational problems.
Evaluates the impact of solutions to ensure goals are achieved.
Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc.
Develops and maintains procedures necessary to meet regulatory requirements.
Ensures that duties comply with hospital established policies, quality assurance programs, safety, and infection control policies and procedures.

Position Qualifications:

Bachelor's degree or equivalent in Business Administration, Health Care Management or related discipline.
Minimum of 5-7 years of experience in a managed care setting, with a thorough understanding of managed care plan operations, is required.
A thorough understanding of clinical operations, hospital and physician billing and health care terminology, and managed care policy required.
Excellent verbal and written communication skills.
Former managerial experience is preferred.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other.
Our six Standards of Respect are:
Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind.
If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org.
We will make every effort to respond to your request for disability assistance as soon as possible.

Read the full job description and apply online on the recuiter's web-site

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