health services. ▪ Maintains accurate and timely documentation, records, and case files in the Partnership HealthPlan... of California (Partnership) Case Management System for members in behavioral health access line management system. ▪ Develops...
, Microsoft Word, Excel, Outlook, Visio, and PowerPoint. Valid California driver’s license and proof of current automobile... insurance compliant with Partnership’s policy are required to operate a vehicle and travel for company business. Performance...
as assigned. Qualifications: Education and Experience Minimum three (3) years claims examining experience; or Partnership... claims examining experience and completion of Partnership claims training; or equivalent combination of education...
effective and high quality projects to meet the needs of associated Partnership departments. Identifies and manages project... requirements and project budget. Valid California driver’s license and proof of current automobile insurance compliant...
. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy.../UM but also HS/CC and internal Partnership’s departments that require support and knowledge of UM’s program and TAR process...
Overview: To plan, manage and evaluate clinical department and/or Partnership delegate(s) performance and compliance... and monitoring activities for applicable providers and entities, and on-going stewardship of NCQA activities to support Partnership...
-specific records in the Partnership computer system, in databases and files as applicable. Participates in committees..., workgroups and/or multidisciplinary teams to support Partnership’s strategic plan, organizational goals, and/or business needs...
a review of all relevant medical records. * Obtain responses from provider(s) and appropriate Partnership departments. When... Conditions (PPCs) and ensures that appropriate notification is sent to appropriate Partnership departments and DHCS Audits...
, Visio, and PowerPoint. Valid California driver’s license and proof of current automobile insurance compliant... with Partnership policy are required to operate a vehicle and travel for company business. . Performance Based Competencies...
management and staff, external clients, and vendors. Valid California driver’s license and proof of current automobile insurance... compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based...
accurate and timely documentation, records, and case files in the Partnership HealthPlan of Californica (Partnership) Case..., vendors, community partners, and Partnership employees. ▪ Supports successful transition of care for members discharged...
effective and high quality projects to meet the needs of associated Partnership departments. Identifies and manages project... requirements and project budget. Valid California driver’s license and proof of current automobile insurance compliant...
Overview: This position provides support and guidance to Partnership HealthPlan of California (Partnership) members... Partnership resources and programs (Healthy Living programs, Case Management support) in accordance with department guidelines...
effective and high quality projects to meet the needs of associated Partnership departments. Identifies and manages project... requirements and project budget. Valid California driver’s license and proof of current automobile insurance compliant...
relationships with Partnership HealthPlan of California partners and providers via open and timely communication. - Participates... training manuals, agendas, materials, and evaluation criteria based upon department and Partnership policies...
are preferred, however not required. Valid California driver’s license and proof of current automobile insurance compliant... with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies...
Overview: Train examiner and customer service level I staff on all related claim types for all Partnership lines...: Education and Experience Minimum two (2) years of claims examining experience and completion of Partnership Claims training...
, facility, and ancillary contracts for the Partnership provider network. The Contract Specialist will also be responsible..., and ancillary contracts for the Partnership provider network. Initiate and negotiate unique Letters of Agreements (LOA). Manage...
California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate.... Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected...
. Works closely with Partnership Compliance Department. Reviews quality control audits to ensure compliance... in Partnership delegated entity audits. Collects, monitors, tracks, and reports claims delegation reporting for capitated entities...