compliance with established criteria and Partnership benefits. Responsibilities: Provides day-to-day direction to Utilization... to the Director of Utilization Management as requested. Assists Partnership staff and providers with the interpretation...
, implementation and evaluation of Partnership’s clinical case management services. Collaborates with Supervisor(s) to oversee the... Current California Registered Nurse License. Certifications in chosen field such as advance practice nursing or case...
in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements and Partnership policies and procedures.... Works with other Partnership departments to resolve issues relating to authorization of medical services. Audits medical...
to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide... into the Care Coordination Department requesting assistance and information about available Partnership programs...
License. Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy..., providers, vendors, community partners, and Partnership employees. * Coordinates referrals and authorizations for services...
, and department metrics are being met. Establishes and maintains professional working relationships with Partnership partners.... Current California Registered Nurse License. Valid California Driver's License and proof of current automobile insurance...
to work well with all levels of internal 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...
with understanding Partnership HealthPlan of California's policies and procedures and assists with resolving issues that arise... Visit Sheet. Investigates and responds to provider concerns. Serves as neutral liaison between providers and Partnership...
for all Partnership lines of business. Responsibilities: Perform concurrent and retro claims audits on new Claims examining staff.... Document audits and report all audit outcomes following the Partnership Claims Operating Instruction Memorandums on claims...
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...
applications. Bi-lingual preferred. 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 Good oral...
to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide... into the Care Coordination Department requesting assistance and information about available Partnership programs...
of various computer system software including Windows, Microsoft Word, Excel, Outlook, Visio, and PowerPoint. Valid California... driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate...
of general business office machines operations. Valid California driver’s license and proof of current automobile insurance... to move, carry, or lift objects of varying sizes, weighing up to 25 lbs. All HealthPlan employees are expected...
of managed care with emphasis in UM preferred. Special Skills, Licenses and Certifications Current California RN/LVN license... and computer data entry skills required. Valid California driver’s license and proof of current automobile insurance compliant...
communication and presentation skills and the ability to interact with all levels of staff and vendors. Valid California driver... size, weighing up to 25 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service...
manuals and reports, weighing up to 25 lbs. All HealthPlan employees are expected to: Provide the highest possible level... HealthPlan’s policies and procedures, as they may from time to time be updated. HIRING RANGE: $28.94 - $34.00 IMPORTANT...