Senior Manager of Managed Care Payer Analytics - Los Angeles, CA
1 day ago
Job description
Description
UCLA Health is seeking a Senior Manager of Managed Care Payer Analytics to advance the organization's managed care contracting strategy through expert financial analysis, contract modeling, and advisory support. Reporting to the Assistant Director of Managed Care Contracting, this role evaluates complex commercial and government payer arrangements including Accountable Care Organizations, Centers of Excellence agreements, Medicare Advantage, Medi-Cal, hospital, medical group, and ambulatory contracts.
This position plays a critical role in strengthening revenue performance and operational efficiency by applying advanced knowledge of managed care payment structures, EMR-based analytics, and forecasting tools. The Senior Managed Care Specialist partners with Finance, Revenue Cycle, Operations, and payer representatives to ensure contract accuracy, regulatory compliance, and strategic alignment with UCLA Health's financial objectives.
In this role, you will:
- Develop and maintain advanced financial models to evaluate complex contract pricing, risk-sharing provisions, projected utilization, and reimbursement methodologies across commercial, Medicare, and Medi-Cal agreements
- Lead EPIC CareConnect contract modeling functions, applying data warehouse tools including EPSi and Tableau to validate assumptions, resolve discrepancies, and ensure modeling integrity
- Analyze payer agreements to identify revenue opportunities, assess policy and rate changes, evaluate financial risk, and recommend contract structure improvements
- Monitor contract performance trends, review reimbursement accuracy, and provide data-driven insights to support negotiation strategy and long-range planning
- Audit shared-risk program performance, prepare ACO analyses, and fulfill recurring and ad hoc managed care reporting requests
- Advise on complex contract terms, chargemaster considerations, service line financial impacts, and regulatory or privacy implications
- Collaborate cross-functionally with Finance, Revenue Cycle, Decision Support, and operational leaders to support forecasting, budgeting, and revenue optimization initiatives
Salary Range: $105,700 – $234,500 annually
Qualifications
We're looking for a strategic and analytical managed care expert with:
- A bachelor's degree in a related field or equivalent combination of education and experience (required)
- A minimum of eight years of related experience in hospital and medical group financial analysis or managed care contracting (required)
- An advanced degree such as MBA or MPH
- Professional certifications such as HFMA CRCR, CPHQ, or coding credentials including CCS or CPC
- Advanced knowledge of managed care contracting principles, reimbursement methodologies, and rate structures
- Strong proficiency with EPIC CareConnect and financial modeling platforms such as EPSi and Tableau
- In-depth understanding of ICD-10 CM/PCS, HCPCS, CPT, and MS-DRG coding frameworks as they relate to reimbursement analysis
- Expertise interpreting commercial HMO/PPO, Medicare, and Medi-Cal reimbursement mechanisms
- Advanced analytical and financial modeling skills with strong attention to detail
- Proven ability to lead complex projects independently and communicate insights effectively to executive and cross-functional stakeholders
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