Managed Care Specialist

Apply for Job Job ID 76796 Location Sacramento Full / Part Time Full Time Add to Favorite Jobs Email this Job

Job Summary

The incumbent of this position serves as a Managed Care Specialist (MCS), directly performs first-line utilization management review of outpatient services / care authorizations, preparing authorization cases for RN clinical review and performing non-clinical case / care management functions as directed by RN case managers. The Managed Care Specialist completes a variety of authorization tasks along with providing information to members, clinics, providers an d health plans in a call center style environment. This work is performed as outlined in the department policies and procedures, often independently within narrow guidelines and with decision-making autonomy based on those guidelines. The incumbent will receive direction from the an analyst supervisor and the department manager concerning the overall goals and objectives of the department.

Apply By Date : March 16,2025 at 11 : 59pm. Selection activities may start at any time.

Minimum Qualifications - For full consideration, applicants are encouraged to upload license and / or certification if required of the position

• Bachelor's degree in related area and / or equivalent work-related experience
• Proficient with use of EPIC
• Proficient with use of window-based computer application (spreadsheets, database management and email systems) and use of system applications such as Outlook, Excel, Word and Adobe
• Knowledge of managed care systems, procedures and regulations.
• Knowledge and understanding of practice patterns, procedures, medical terminology, diagnostic testing and services provided in an ambulatory or institutional setting.
• Knowledge of the referral criteria, service location specifics and complexity of appropriate patient referral direction.
• Proficient with use of electronic medical review.
• Excellent communication and interpersonal skills to interact professionally and compassionately with patients and families while still accomplishing tasks in an efficient manner
• Ability and willingness to establish a good rapport and professional working relationship with all departmental personnel. Ability to maintain appropriate inter-departmental communications.
• Willingness to readily assist co-workers and strive to reduce tension and anxiety among staff members.
• Independent judgment to incorporate established policies and procedures, to improve workload, prioritize assignments and streamline departmental processes.
• Demonstrate strong analytical skills to review all available information, draw conclusions, develop and evaluate alternatives and develop solutions.
• Ability to be diplomatic, informative, courteous and tactful in all contacts with hospital personnel, the public and outside agencies. Demonstrates proficiency and excellence in specific area of conflict management and patient complaint management.
• Knowledge and ability to adhere strictly to HIPAA and privacy guidelines.
• Ability to be flexible and responsive to a rapidly changing workflow.

Preferred Qualifications

Key Responsibilities

Department Overview

The Managed Care Utilization Management department includes the combined responsibilities of Utilization Management, Member Services and care coordination, as well as data analytics for auditing compliance with regulatory and contractual metrics for HMO and ACO populations. The department interacts daily with all levels of staff in the ambulatory clinics, both hospital-based and primary care network sites, the Patient Relations and Physician Referral Center staff, multiple community providers and care partners with UC Davis Medical Group and most importantly, members enrolled in the Managed Care HMO Health Plans. The Utilization Management (UM) unit of the department insures services / care rendered to UCDMG capitated members are medically necessarily / appropriate and in conformance clinically with the benefits of the me member's Health Plan.

POSITION INFORMATION

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC : https : / / ucnet.universityofcalifornia.edu / labor / bargaining-units / index.html

Physical Demands

Mental Demands

Work Environment

UC Davis is a smoke and tobacco free campus effective January 1, 2014. Smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) will be strictly prohibited on any UC Davis owned or leased property, indoors and outdoors, including parking lots and residential space.

Special Requirements - Please contact your recruiter with questions regarding which activities apply by position

Misconduct Disclosure Requirement : As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Diversity, Equity, Inclusion and Belonging

At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds and you belong here. As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected. The University of California, Davis is an Equal Opportunity / Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy, please visit : https : / / policy.ucop.edu / doc / 4010393 / PPSM-20

For the University of California's Anti-Discrimination Policy, please visit : https : / / policy.ucop.edu / doc / 1001004 / Anti-Discrimination

Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere

To learn more about our background check program, please visit : https : / / hr.ucdavis.edu / departments / recruitment / ucd / selection / background-checks

Salary : $29 - $49