Manager, Enrollment & Eligibility – Managed Care

Requisition # HRC1010621

The Manager, MN Managed Care Enrollment and Benefits is responsible for processes associated with the internal maintenance of MDN provider data accuracy related to and communicated by Cedars-Sinai Medical Delivery Network on behalf of Cedars-Sinai Medical Care Foundation and affiliated medical groups.

Job Duties and Responsibilities:

• Is responsible for the full scope of implementation of new or amended Medical Network (MDN) ancillary and provider contracts.
• Understands the overall operations of the business to integrate provider information in its varied formations and functions.
• Serves as a consultant to the Training Team’s management to develop or revise training curriculum related to MDN Provider Data management workflows.
• Engages key collaborators within Cedars-Sinai Health System (CSHS) Managed Care & Payor Relations, Physician Billing (PBS) and MDN Network Management to develop standardized workflows for internal and external provider set-up.
• Manages staff to ensure paneling information provided to Health Plans is accurate and timely to support Senate bill AB137.
• Collaborates with Cedars-Sinai Medical Center (CSMC) and MDN operational departments to identify and resolve issues within CSHA/CSMG HMO referral data bases.
• Develops audit mechanism(s) to identify system discrepancies which may impact referrals and claims.
• Develops clear and concise educational materials regarding PIF and CRM completion.
• Manages and approves Provider Information Forms (PIFs) related to the MDN’s managed care business.
• Manages the validation of MDN-related fields within Epic’s Provider (SER) records.
• Assumes responsibility for the accuracy of ancillary and provider contract data within EPIC’s Tapestry Module and associated HMO referral system(s) operations.
• Is responsible for the accuracy of internal rosters to mitigate inadvertent leakage resulting from incorrect listings.
• Reports high impact concerns/issues to leadership via the biweekly Managed Care Operations meeting.
• Prepares policies and procedures as requested.

Education:

High school diploma/GED required. Bachelor’s degree preferred.

Experience:

Five (5) years of experience in Managed Care required.

Working Title:

Manager, Enrollment & Eligibility – Managed Care

Department:

MNS – Managed Care

Business Entity:

Medical Network

Job Category:

,Strategic Plan/Business Dev,Strategic Plan/Business Dev

Job Specialty:

Managed Care

Position Type:

Full-time

Shift Length:

8 hour shift

Shift Type:

Day

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at [email protected] and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.

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