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Minimum Education:
Preferred Education:
Minimum Experience:
Preferred Experience:
Required Certification:
Preferred Certification:
Required License:
Preferred License:
Under the direct supervision of the Sr. Director – Strategy, the Managed Care Operations Manager, oversees responsibilities for all capitated functions including, facility and ancillary contracting. Negotiate to minimize financial risk and legal issues, while communicating contractual terms to ensure smooth administration of contracts. Provide plan wide strategy and support through contract analysis, consultation in new program development and assist in contract reimbursement modeling for the annual budgeting process. Develop and manage Palomar Health projects as a result of legislation changes or updates. Responsible for operational support system to respond to contract informational needs and monitor facility issues regarding contracting priorities. Provide operational support to internal and external customers. Meet with Controller/CFO, and Director to discuss strategy.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.
Job Requirements
Minimum Education:
Bachelor’s Degree in accounting, finance, business administration, healthcare or related field
equivalent
equivalent
Preferred Education:
Masters Degree
Minimum Experience:
5-7 years Managed Care
Preferred Experience:
7+ years Managed Care
Required Certification:
Not Applicable
Preferred Certification:
Not Applicable
Required License:
Valid Driver’s License
Preferred License:
Not Applicable
