Senior Manager of Managed Care Payer Analytics

UCLA HEALTH

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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 annuallyQualifications

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