Glen Burnie, Maryland
Roseville, California
Battle Creek, Michigan
Boise, Idaho
Los Angeles, California
West Haven, Connecticut
Georgia
Posted: 18-Feb-25
Location: Los Angeles, California
Categories:
Internal Number: 146296467
We are seeking an experienced and dynamic Senior Manager for our UCLA Health Medicare Advantage Plan Delegation Oversight Program to monitor the performance of contracted entities, including Independent Physician Associations (IPA) and other vendors. This pivotal role ensures compliance with regulatory guidelines, adherence to operational standards, and continuous performance improvement to optimize member experiences and drive operational excellence.
You will:
• Oversee the performance of delegated entities to ensure alignment with regulatory requirements and operational standards
• Leverage data analysis to identify risks, inefficiencies, and areas for improvement, implementing corrective action plans as necessary
• Coordinate with health plan departments such as utilization management, claims, health services, network management, and compliance to address performance gaps and streamline processes
• Manage audit readiness efforts and maintain performance dashboards to monitor key metrics and performance indicators (KPIs)
• Lead and mentor a team of professionals, fostering a culture of accountability, collaboration, and continuous improvement
• Drive operational excellence by leveraging best practices, fostering collaboration, and contributing to the strategic direction of the Medicare Advantage Plan
Salary Range: $83,800-$179,400/annually
We’re seeking a dynamic leader with:
• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field (Master’s degree preferred), or a combination of equivalent education, training and experience
• Seven or more years of experience in healthcare operations, care management, or related health plan operations functions, including at least three years in a leadership role, required
• In-depth knowledge of Medicare Advantage (MA), NCQA standards, and CMS regulatory requirements, required
• Proven ability to manage complex projects and cross-functional teams, required
• Proficiency in data analysis, performance monitoring systems (e.g., Innovare), and reporting tools, required
• Experience with Independent Physician Associations (IPAs) and delegated vendor management
• Expertise in process improvement methodologies such as Lean or Six Sigma
• Demonstrated ability to develop and implement operational policies and procedures
• Exceptional interpersonal and communication skills, with the ability to foster collaboration and build strong relationships across diverse teams
