Managed Care Regulation Specialist - Managed Care Operations - FT Days

Who We Are

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center , a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America's Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County's only National Cancer Institute-designated comprehensive cancer center , high-risk perinatal / neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center , gold level 1 geriatric emergency department and regional burn center . UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

To learn more about UCI Health, visit www.ucihealth.org.

Your Role on the Team

Position Summary :

The Managed Care Regulatory Specialist is a strategic role in the managed care operations that is responsible for ensuring comprehensive regulatory compliance and driving performance excellence across value based care operations. This position combines deep regulatory expertise with advanced analytics capabilities to optimize health plan relationships and quality outcomes. A strong understanding of the health plan and regulatory requirements is essential. Position is responsible to manage all internal and external inquiries and audits including responses to health plans. Use of data and analytics will inform improvement opportunities

What It Takes to be Successful

Required Qualifications :

• Strong critical thinking skills
• Strong commitment to the values of the organization : Academic Achievement, Respect, Integrity, Service and Excellence
• Prior supervisory experience
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Minimum of 8 years of experience in utilization management, prior authorization, inpatient and discharge planning in a managed care / insurance setting
• Knowledge of operations and healthcare management with commercial and Medicare populations, preferable in Southern California area
• Excellent written and verbal communication skills in English
• Excellent negotiation skills and proven ability to influence others internal and external to the organization
• Current California RN license
• Bachelor's Degree in Business, Healthcare Management, BSN, or a related field, or an equivalent combination of education and experience
• Bachelor's Degree in Business, Healthcare Management or a related field, or an equivalent combination of education and experience
• Advanced knowledge of relevant Managed Care industry laws, regulations and business / industry trends. Ability to apply policy knowledge to proactively identify potential risk areas
• Ability to successfully represent UC Irvine Health to the external community
• Ability to maintain a work pace appropriate to the workload
• Ability to establish and maintain effective working relationships both across the Health System and externally with payors and health plans
• Ability to develop and maintain a team
• Ability to adapt, change and pivot within our highly dynamic environment

Preferred Qualifications :

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits .

Conditions of Employment :

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment :

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

Details of each policy may be reviewed by visiting the following page : https : / / hr.uci.edu / new-hire / conditions-of-employment.php

Closing Statement :

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy .

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at eec@uci.edu or at (949) 824-0500, Monday - Friday from 8 : 30 a.m. - 5 : 00 p.m.

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization