Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Key Details: Must be a Board Certified Psychiatrist and licensed in either California
Internal Candidates are welcome to apply if you are willing to obtain an RN license for the state of California PLEASE NOTE: The California RN license background check and RN license approval is required PRIOR to
Position Purpose: The Strategy & Planning Manager – California Market serves as staff support primarily for the Population Health and Clinical Operations Executive of the California market. This position plays a key role by providing strategic,
Position Purpose: The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are carved out of the health plan contract with the Department of Health
Position Purpose: Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost effective care. Completes medication review for pre-admission
Position Purpose: Conduct analysis, pricing, and risk assessment to evaluate and project Medicare Advantage financial performance. As part of the Medicare Actuarial Forecast & Financial Performance Team, this role supports quarterly forecasting, Medicare bid target setting,
Position Purpose: The Senior Business Process Consultant leads business case development for proposed initiatives, supports the strategic planning process, and leads larger scale, cross-functional initiatives. Key Details: Must be authorized to work in the U.S. without
Position Purpose: This position will be accountable for the performance of a portfolio of Medical Management initiatives and the implementation of the Health Equity Cultural Competency Program. Key Details: Must be authorized to work in the
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member
Position Purpose: Provides support with identifying, overseeing, and managing the coordination of transition of members in the community. Works with leadership to ensure the timely and safe transition of members in the community from various levels
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families
Position Purpose: Performs concurrent reviews, including determining members overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to
Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Key Details: Must be authorized to work in the U.S. without the need for
Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks UM resources to ensure adherence to performance,