Managed Care Operations Manager

Exemption Status:

Hiring Range:

Please note that the final offer may vary within this range based on a candidates experience skills qualifications and internal equity considerations.

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

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

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 20000 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:

• Bachelors 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.

Were 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 We will make every effort to respond to your request for disability assistance as soon as possible.