Top Managed Care Executive jobs in Escondido, CA

Top Managed Care Executive plans and directs all aspects of an organization's managed care function. Responsible for directing and implementing managed care systems for healthcare facilities. Being a Top Managed Care Executive requires a bachelor's degree. Typically reports to a top management. The Top Managed Care Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Managed Care Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Data Management Specialist
  • Southern California Physicians Managed Care...
  • San Diego, CA FULL_TIME
  • Department:
    Information Technology

    Level:
    Non-Supervisory

    Reports To:
    Directory of Information Technology and Security

    Private Health Information (PHI):
    Position has complete access to electronic PHI.

    Job Classification:
    Exempt

    Job Type:
    Full time - Four-Day 10 hour days, Monday - Thursday

    Pay Rate:
    $33.47 – $42.68 an hour. Salary is based on qualifications and experience.

    Position Summary:
    Responsible for ensuring that HIPPA compliant formats and best practices are used for electronic data exchange throughout the organization by monitoring and managing the performance of all systems and monitoring adherence to all related policies and procedures.

    Essential Job Functions:
    This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its' employees will need to assume other "non-essential functions" not listed herein which support company business objectives. This may include duties which fall outside of normal position scope.
  • Ensures that HIPPA compliant formats and best practices are used for electronic data exchange throughout the organization by monitoring and managing the performance of the Data Warehouse, the Electronic Authorization System, Electronic Claims Systems, Electronic Eligibility and Data Exchange services on the SCPMCS Website and FTP services.
  • Manages and controls all batch inload/outload of data to the EZ-Cap system to ensure accuracy and timeliness.
  • Facilitates the transition from manual to electronic communications to achieve greater participation by providers. Works with the Network Management Department to obtain provider participation.
  • Manages all EDI processing and server data related to all data exchange systems to achieve conformance with policies and procedures. Manages user registration for HealthPlan portals and end user access training.
  • Recommends data formats and ensures that data content and transmission methods are compliant with HIPAA standards. Recommends organizational wide policies and procedures for data exchange into and out of the organization, and monitors adherence to those procedures.
  • Participates in regular and temporary teams as assigned by the Director of Information Technology.
  • Coordinates software Vendors, IT Staff, Providers, Health Plans and SCPMCS Departments to create and maintain HIPAA compliant systems and procedures for data exchange.
  • Reports all security, privacy and procedure breaches to the Director of Information Technology immediately.
  • Performs other duties as assigned, including cross training and coverage of the IT Department.

Position Qualifications and Requirements:
Experience/Specialized Skills::
  • Proven experience managing multiple electronic environments for data exchange with Trading Partners in both batch and interactive environments, internally and externally.
  • Must be familiar with and have experience with EDI X12 Transaction Sets, EDI Mapping Applications and multiple protocols in a medical transaction environment.
  • Must have strong working knowledge of Windows Desktop and Server Administration. Working knowledge of MS Office, Excel and Word, and Adobe Acrobat.
  • Working experience with EZ-Suite (EZ-Cap, EZ-Net) not required by preferred.
  • Proven ability to work with multiple projects with internal personnel and Trading Partners in a professional manner. Excellent interpersonal skills are essential.
  • Must be able to occasionally work evenings and weekends as needed.

  • Education/Course(s) /Training:
    • Bachelor’s Degree in Information Systems or Business Administration preferred. Network Administration, Desktop Support and Database Administration a plus.

    Licensure/Certification:
    N/A

    Location:
    Mira Mesa, San Diego

    Date Posted:
    January 25, 2024

    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org
  • 2 Days Ago
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    P
    PBM / Managed Care Pharmacist
    • Pharmacy Careers
    • San Diego, CA FULL_TIME
    • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
    • 1 Month Ago
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    S
    Provider Relations Representative
    • Southern California Physicians Managed Care Services
    • San Diego, CA FULL_TIME
    • Position Title: Provider Relations Representative Department: Network Management Level: Non-Supervisory Reports To: Director of Network Management Position's Access to Private Health Information (PHI)...
    • 20 Days Ago
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    C
    Executive Assistant
    • Crunch Care
    • Rancho Santa Fe, CA CONTRACTOR,FULL_TIME
    • Job Title: Executive Assistant Location: Relocating to Rancho Santa Fe, California Company: Confidential Job Type: Full-time Salary: $80,000 - $100,000 per year, paid bi-weekly Overview: Seeking a hig...
    • 2 Days Ago
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    F
    Executive Assistant
    • Fresenius Medical Care
    • San Diego, CA FULL_TIME
    • POSITION FEATURES:Reports to the Western Group Senior Vice President of Operations and also supports Regional Vice President for San Diego Inland Empire MarketPerson to live in Pacific Time Zone is pr...
    • 7 Days Ago
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    M
    Mobile Diesel Technician - Advanced
    • Managed Mobile
    • San Diego, CA FULL_TIME
    • Managed Mobile is looking for an advanced level Journeyman Technician with a wide breadth of experience who can diagnose and repair medium/heavy duty trucks. The selected candidate will work independe...
    • 23 Days Ago
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    0 Top Managed Care Executive jobs found in Escondido, CA area

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    Full Time RN - Escondido VA Clinic
    • CRAssociates, Inc
    • Escondido, CA
    • Job Description Job Description CRAssociates is looking for an enthusiastic full-time Registered Nurse to join our team ...
    • 4/26/2024 12:00:00 AM

    D
    Internal Revenue Agent (Reviewer - Examiner) Temp NTE 1 Yr., MBE, MBMP 12 MONTH ROSTER (Amended)
    • Department Of The Treasury
    • San Marcos, CA
    • Duties WHAT IS THE SMALL BUSINESS/SELF EMPLOYED (SBSE) DIVISION? A description of the business units can be found at: ht...
    • 4/26/2024 12:00:00 AM

    D
    Legal Admin Specialist (Estate & Gift Tax) (Estate Tax Technical Advisor) (TEMP NTE 1 YR MBE, MBP)
    • Department Of The Treasury
    • San Marcos, CA
    • Duties WHAT IS THE SMALL BUSINESS SELF EMPLOYED (SBSE)DIVISION? A description of the business units can be found at: htt...
    • 4/26/2024 12:00:00 AM

    N
    General Manager-Carmel Mountain
    • NEKTER JUICE BAR INC
    • San Diego, CA
    • Job Details Job Location Carmel Mountain - San Diego, CA Position Type Full Time Salary Range $21.00 - $27.00 Hourly Tra...
    • 4/26/2024 12:00:00 AM

    D
    Senior Director, North America Sales
    • Danaher Corporation
    • Escondido, CA
    • Do you want to help advance scientific discovery, improving quality of life around the world? We do, too. Molecular Devi...
    • 4/23/2024 12:00:00 AM

    R
    Branch Manager
    • Roundpoint Mortgage Servicing Corporation
    • Escondido, CA
    • **Branch Manager**at RoundPoint Mortgage Servicing Corporation Escondido, CA **Summary**The Branch Manager is responsibl...
    • 4/23/2024 12:00:00 AM

    D
    Internal Revenue Agent (Senior Revenue Agent (Examiner) -12 MONTH ROSTER
    • Department Of The Treasury
    • San Marcos, CA
    • Duties WHAT IS THE SBSE - SMALL BUSINESS SELF EMPLOYED DIVISION? A description of the business units can be found at: ht...
    • 4/22/2024 12:00:00 AM

    E
    Sr. Project Manager
    • Energy Services West, LLC
    • San Diego, CA
    • About Us: Energy Services West, a subsidiary of Quanta Services, Inc. (NYSE: PWR), provides front-end design services, c...
    • 4/22/2024 12:00:00 AM

    According to the United States Census Bureau, the city has a total area of 37.0 square miles (96 km2). 36.8 square miles (95 km2) of it is land and 0.2 square miles (0.52 km2) of it is water. The total area is 0.48% water. The city is growing at a rapid rate with new communities like Hidden Trails appearing at the east end of East Valley Parkway. The city proper is surrounded by several sparsely populated unincorporated communities. These include Jesmond Dene and Hidden Meadows to the north; Felicita Park to the southwest; and Rincon Del Diablo to the southeast. Residents of these communities...
    Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
    Income Estimation for Top Managed Care Executive jobs
    $225,426 to $399,938
    Escondido, California area prices
    were up 2.6% from a year ago

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