Employer Industry: Healthcare Management Services

Why consider this job opportunity:
- Opportunity to work from home within California
- Comprehensive Total Rewards package including a flexible Health & Welfare benefits program
- Competitive pay with a generous employer-matched 401k retirement plan
- Paid Time Off and Sick Leave benefits
- Opportunity to lead complex projects and drive operational efficiency improvements
- Chance to collaborate with cross-functional teams and make an impact in managed care operations

What to Expect (Job Responsibilities):
- Analyze and evaluate data, processes, and systems related to Managed Care Operations to align with strategic business goals
- Oversee improvements across functional areas, including credentialing, contracting, provider relations, and care coordination
- Serve as the subject matter expert for the Managed Care Operations Hub, integrating operational needs with data governance and reporting
- Develop business cases for process improvements, considering cost, service, and benefit dimensions
- Manage complex projects and provide recommendations to leadership for operational efficiency improvements

What is Required (Qualifications):
- 5+ years of experience in business analysis within managed care operations, including contracting and claims management
- Bachelor's degree or 5 years of equivalent work experience in healthcare administration, managed care business, information technology, or related fields
- Advanced proficiency in data analysis tools (e.g., SQL, PowerBI, Excel)
- Strong experience in stakeholder management, reporting, and performance monitoring within managed care environments
- Familiarity with HIPAA regulations and data governance best practices

How to Stand Out (Preferred Qualifications):
- Master's degree in computer science, mathematics, management information systems, or a closely related field
- Experience leading cross-functional teams within managed care operations with a focus on strategic project management
- Advanced knowledge of data governance, data integration, and reporting systems within managed care
- Familiarity with healthcare data standards and managed care systems (e.g., EZCAP, Qnxt, ImageNet)
- Proven ability to translate business needs into technical solutions while collaborating with IT teams

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