Manager, Value Based Care Operations presso Adventist Health Portland
Adventist Health Portland · Glendale, Stati Uniti d'America · Onsite
- Professional
- Ufficio in Glendale
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Supports the operational and regulatory functions of health plan restricted Knox-Keene Act (RKK) and independent physician association (IPA). Ensures timely implementation of regulatory requirements, maintaining effective oversight of delegated entities, and supporting cross-functional coordination through structured reporting and meeting management.
Job Requirements:
Education and Work Experience:
- Bachelor's degree in health information management, business administration, health administration or related field or equivalent combination of education/related experience: Required
- Master's Degree: Preferred
- Five years' of experience in health plan regulations, medical terminology and insurance procedures: Preferred
- Experience utilizing Microsoft technologies: Preferred
- Thorough understanding of health plan regulations, medical terminology and insurance procedures to ensure accurate information delivery. Experience with Medi-Cal, commercial and Medicare managed care plans: Required
Licenses/Certifications:
- Valid Driver’s License (DL) and must be at least 21 yrs of age or older: Required
Essential Functions:
- Acts as the subject matter expert for health plan operational setup, including claims workflows, eligibility/PA file exchange, accumulator data, and utilization management workflows, quality management/HEDIS coordination. Manages project plans, timelines, and milestones to ensure timely and accurate delivery. Prepares agendas, materials, and documentation for internal and external meetings. Manages meeting calendars, coordinate scheduling, and ensure timely follow-up on action items. Provides administrative support to leadership and cross-functional teams as needed.
- Populates and maintains recurring reports and dashboards to monitor compliance, operational performance, and project milestones. Tracks and follows up on outstanding items, ensuring accountability and timely resolution. Supports audit readiness and documentation for internal and external reviews.
- Maintains and manages the delegation oversight audit calendar. Coordinates with internal stakeholders and delegated entities to ensure timely completion of audits and corrective actions. Assists in compiling audit documentation and tracking outcomes.
- Serves as a liaison between departments to ensure alignment on compliance and operational initiatives. Supports the development and maintenance of workflows and procedures that promote efficiency and regulatory adherence. Provides network operations coordination, including network expansion operations deployment.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
