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Full Time
6/10/2025
Los Angeles, CA 90232
(11.0 miles)
Overview: Physical Therapist Assistant (PTA)Your Schedule, Your Way!What sets EmpowerMe Wellness apart from other therapy providers It’s simple: we offer truly flexible scheduling. Need to be home for family or other obligations No problem! You can easily adjust your day to fit your needs all while making a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a Physical Therapist Assistant (PTA) to join our team and work with the residents of a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a PTA, you will be responsible for: Providing physical therapy and wellness services for older adults under the supervision of a PTMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesContributing to program development, quality improvement, and problem-solvingAssist with optimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffYou’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accredited Physical Therapy Assistant program (New Grads Welcome) Current PTA state licensure Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today! Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $45.00 per hour
Full Time
6/10/2025
Long Beach, CA 90899
(28.1 miles)
Your Role The Behavioral Health Teamis responsible the coordination of care and assistance in finding providers for members in need. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor, Operations -Behavioral Health . In this role you will be for supporting clinical staff day-to-day operations.Your Work In this role, you will: Work in a production-based environment with defined production and quality metrics.Process Faxed /Web Portal /Phoned in Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.The CSC will oversee designated queues and workstreams, with standardized reports to detect and address member needs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider networksData entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.Serves as an initial point of contact for providers and/or members in the behavioral health management process by telephone or correspondence.Assists with system letters, requests for information and data entry.Provides administrative/clerical support to Behavioral Health management.Your Knowledge and Experience Requires a high school diploma or equivalentRequires at least 3 years of prior relevant experienceDesired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.
Full Time
6/10/2025
Pasadena, CA 91105
(10.8 miles)
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve grown from a small 16-bed hospital to a nationally recognized healthcare leader with 619 beds. As part of our commitment to providing equitable, high-quality care to all members of our community, we embrace differences and work hard to create a place of belonging for our patients and our employees. When you join the Huntington family, you’ll be empowered to enact change that continuously improves our ability to deliver world-class care, with kindness and dignity, to all who need it.** Internal Workers – Please log into your Workday account to apply **Huntington Hospital Employee LoginCompensation Range:Anticipated compensation range of $66.19 - $74.67 / Hour depending on qualifications and experience.Department:764000 Rad-TherapeuticExpectations:Under limited supervision and as assigned by the Chief Radiation Therapist, provides daily treatment for cancer patients. Positions and adjusts equipment for proper daily dose and operations. Records necessary information pertaining to daily treatment and patient concerns. Maintains assigned work area in a neat and orderly fashion. Use of computers a must. This position may require flexibility of hours.EDUCATION:AA Degree or Graduate from an approved AMA school of Radiation Therapy TechnologyEXPERIENCE/TRAINING:Minimum 2 years experience as Radiation Therapist working in the field preferred. High dose rate brachytherapy experience preferred. Graduate of an accredited School of Radiation Therapy Technology.LICENSES/CERTIFICATIONS:Required:Current Certified Radiologic Technologist (CRT) issued by California Department of Public Health (CDPH)Certified Radiologic Technologist (CRT) Fluoroscopy Permit issued by California Department of Public Health (CDPH)Current Basic Life Support Provider (BLS) issued by American Heart AssociationPreferred:Current American Registry of Radiologic Technologists (ARRT) certification issued by the American Registry of Radiologic TechnologistsSKILLS:Knowledge of computers, anatomy, physiology, linear accelerators, simulators, high dose rate brachytherapy, moderate understanding of treatment planning, knowledge of equipment, body mechanics, isolation procedures and standard precautions.Worker Type:Per DiemPart timeShift:Days
Full Time
6/2/2025
Thousand Oaks, CA 91320
(33.9 miles)
Overview: Clinic Director – Licensed Clinical Occupational Therapy Assistant (COTA) - Care Coordination ProgramOccupational Therapy + Care Coordination: The Best of Both Worlds!We’re looking for COTAs to support our innovative new care coordination program! This opportunity empowers you to practice at the top of your license, while giving you the chance to branch out into care coordination duties designed to standardize your hours and grow your career. All this plus truly flexible scheduling, amazing benefits, and the ability to make a huge difference in the lives of seniors!Incentive OpportunitiesFor some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The OpportunityWe are hiring a licensedClinical Occupational Therapy Assistant (COTA) to serve as Clinic Director at a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a Clinic Director, you will be responsible for:Overseeing how team members at your location(s) deliver care in accordance with federal, state, and local regulations Support care coordination efforts by conducting regular wellness checkpoint visits with patients, communicating with patients’ providers and caregivers, and assisting patients with attending telehealth visitsLeading operational initiatives, including the implementation of company-wide policies, clinical programs, and quality initiativesCollaborating with interdisciplinary care partners on treatment planning and therapeutic interventionsMaintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiativesAs a COTA, you will be responsible for: Providing occupational therapy and wellness services for older adults under the supervision of a OT as part of a multidisciplinary teamContributing to program development, quality improvement, and problem-solvingAssisting with optimizing each patient’s functional well-being and satisfactionYour ScheduleWhile our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle!Our Amazing BenefitsAll Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching FundsAmazing Career Advancement and Cross Training OpportunitiesRecognition ProgramsEmployee Assistance ProgramPart-Time Employees Also Get:Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Full-Time Employees Also Get:Full Benefits, including HSA, FSA, and Life & Disability InsuranceVoluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection)Flexible Paid Time OffYou’re Our Perfect Fit If...You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a jobyou seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights.Plus, you have the following: Completion of an accredited Clinical Occupational Therapy Assistant program (New Grads Welcome) Current COTA state licensure Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! Professional curiosity and a knack for finding solutionsCome be a part of our mission to make a positive impact on the lives of seniors. Apply today! Qualifications: About EmpowerMe WellnessEmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows!To learn more about us, visit empowerme.com today.This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $33.00 - $45.00 per hour
Full Time
6/10/2025
Long Beach, CA 90899
(28.1 miles)
Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Commercial Utilization Management is critical to the success of Blue Shield of California (BSC) and the Utilization Management (UM) department in realizing its goals and objectives. This individual will play a key role as part of UM team in delivering and collaborating on all aspects of utilization management and care coordination for Commercial membership. The Director, Commercial Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics. This role requires weekly travel to an approved BSC office, and monthly travel to the Rancho Cordova BSC office. Ad hoc travel as needed.Your WorkIn this role, you will:Manage and monitor prior authorization and concurrent review to ensure that the patient is getting the right care in a timely and cost-effective wayLead development of UM strategy by leveraging the use of data/analytics to inform and technology solutions to streamline operational efficiencies while also building a cost-benefit methodology to rationalize decisions on UM reviews to be performed based upon staffing costs, productivity, and projected medical cost savingsProvide analysis and reports of significant utilization trends, patterns, and resource allocation. Partner with physicians and others to develop improved utilization of effective and appropriate servicesEstablish and measure productivity metrics in order to support workforce planning methodology and rationalization of services required to perform UM reviewsReview and report out on Utilization Review (UR) trending for Commercial membershipEnsure alignment of the authorization strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of careManage strategic projects and support operations initiativesLead operational implementation of transformation changes (organizational management, process implementation, technology adoption)Lead operational teams' performance, resource management, continuous improvement, and trainingLead operational audit readiness, ensure adequate processes and internal audit measures are in place and maintained quarterlyEnsure all operational processes are meeting regulatory and accreditation requirementsFoster a culture of process excellence, BSC leadership principles, and a great place to work environmentYour Knowledge and ExperienceRequires current CA RN LicenseBachelors of Science in Nursing or advanced degree preferredMaster’s degree or equivalent experience preferredMinimum of 10 years prior relevant experience, including 6 years of management experienceMinimum of 5 years of progressive leadership in Utilization Management operations, preferredHealth plan or similar health care organization structure experience requiredSuccessful track record in driving organizational change managementExcellent relationship and consensus-building skills required#LI-JS3
Full Time
6/10/2025
Pasadena, CA 91105
(10.8 miles)
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve grown from a small 16-bed hospital to a nationally recognized healthcare leader with 619 beds. As part of our commitment to providing equitable, high-quality care to all members of our community, we embrace differences and work hard to create a place of belonging for our patients and our employees. When you join the Huntington family, you’ll be empowered to enact change that continuously improves our ability to deliver world-class care, with kindness and dignity, to all who need it.** Internal Workers – Please log into your Workday account to apply **Huntington Hospital Employee LoginCompensation Range:Anticipated compensation range of $124,584.00 - $155,570.00 / Year depending on qualifications and experience.Department:617101 Med Tele Stn45Expectations:Responsible for assisting the Department Managers in supervising, planning, coordinating and evaluating patient care and employee performance. Ensures effective unit operation and supports staff with challenging issues, assists with care coordination and serves as first line on-site support/resource for employees, physicians and patients. Meets all job requirements of the Registered Nurse. This position requires flexibility of hours.EDUCATION:Bachelor's Degree in Nursing (BSN) required.EXPERIENCE/TRAINING:Minimum three (3) years of clinical experience in the specific area of expertise or equivalent service area, including at least 2 years of recent experience in the specific area of expertise or equivalent service area.Five (5) years of experience and demonstrated leadership capabilities preferred.LICENSES/CERTIFICATIONS:Required:Current unrestricted Registered Nurse (RN) license issued by California Board of Registered Nursing (BRN)Current Basic Life Support Provider (BLS), Advanced Cardiovascular Life Support (ACLS) issued by American Heart AssociationPreferred:Board Certification in Med-surg or any American Nurses Association (ANA) recognized professional nursing certification.SKILLS:Good managerial, communicative and organizational skills.Competency to utilize computer systems including Health Information System and Office applications at an intermediate level is expected.Worker Type:RegularFull timeShift:Nights
Full Time
6/10/2025
Long Beach, CA 90899
(28.1 miles)
Your Role The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Sr. Medical Director, Medical Policy will report to the Chief Medical Officer. In this role you will be accountable for ensuring that all medical, medication, and payment policy initiatives are in aligned with the scientific evidence and professional guidelines. You will lead a team that delivers medical policy that adapts to new clinical innovations and supports medical payment operations, and training for staff in the accurate application of medical, medication, and payment policy, pricing, and coding. In addition to chairing the BSC Pharmacy & Therapeutics, Medical and Payment Policy Committees, you will provide clinical leadership for all evidence-based medicine functions and partner closely with leaders of other business functions to develop strategies to ensure that Blue Shield members are receiving appropriate quality care.Your WorkIn this role, you will:Provide clinical thought leadership for the design and implementation of clinical policy innovation initiatives such as Coverage with Evidence Development, and the development of robust and efficient approaches to developing policies for emerging classes of technology like molecular diagnostics and mobile/digital personal health devicesChair the Medical Policy and Pharmacy and Therapeutics CommitteesProvide clinical leadership and medical consultation for the Blue Shield of California (BSC) medication management process, including working closely with the Pharmacy Services team to promote safe, effective, and cost-efficientProvide medical expertise in daily clinical rounds for drug authorization case reviewChair the Payment Policy Committee and provide clinical leadership for the BSC Payment Policy committee, overseeing and advising about payment policies and tactical approaches to ensure accurate coding of servicesConsult with BSC legal team to support fraud and abuse investigations, provider arbitrations, regulatory inquiries and issues, and litigation related to clinical policy, coding, or pricing issuesAct as BSC’s representative to the Blue Cross Blue Shield Association (BCBSA) Technology Assessment process and the Medical Policy PanelParticipate on the California Technology Assessment Forum and other related activitiesPartner with Network Management and Provider Partnership teams by providing subject matter expertise for contract and benefits coding decisions, including mandated benefits, provider contract language, provider DOFRs (division of financial responsibilities), and providing clinical perspective to resolve issues with BSC providers related to clinical policy, coding, and billing.Provide subject matter expertise for pricing of new, zero-dollar, and other exceptional claimsPresent at IPA/MG and Provider education seminars regarding medical, medication and payment policy Your Knowledge and ExperienceMinimum of 2 years of previous medical leadership experienceMinimum of 5 years of direct patient care experience post residencyMinimum of 8 years of experience developing evidence-based guidelines, medical policies or performing systematic reviews of the medical literatureMedical degree (M.D./D.O.) required. Master’s degree in epidemiology, health services or related degree is preferredCompleted residency preferably in adult based primary care specialty (e.g. Internal Medicine, Family Practice)Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states requiredMaintain Board Certification in one of ABMS, ABOS, or AOA recognized specialty required (preferably Internal Medicine or Family Practice)Has mastery level knowledge and skills within a specific technical or professional discipline with broad understanding of other areas within the job functionOutstanding verbal and written communication skillsAbility to lead through influence in a matrixed organizationExperience performing utilization management reviews is preferredExperience in a health plan or managed care organization is preferred#LI-JS3
Full Time
5/30/2025
Pasadena, CA 91105
(10.8 miles)
When you join the Huntington Hospital team, you are aligning yourself with an organization whose values drive our philosophy of compassionate community care. Over the past 129 years, we’ve grown from a small 16-bed hospital to a nationally recognized healthcare leader with 619 beds. As part of our commitment to providing equitable, high-quality care to all members of our community, we embrace differences and work hard to create a place of belonging for our patients and our employees. When you join the Huntington family, you’ll be empowered to enact change that continuously improves our ability to deliver world-class care, with kindness and dignity, to all who need it.** Internal Workers – Please log into your Workday account to apply **Huntington Hospital Employee LoginCompensation Range:Anticipated compensation range of $23.00 - $32.20 / Hour depending on qualifications and experience.*12 hour shifts at Huntington Health are overtime-based (not a straight time rate for all 12 hours). Therefore, employees who work a full 12-hour shift will be paid their base rate for 8 hours AND overtime (1.5) for hours up to 12.Department:617901 Cardiothoracic Tele Unit 5WExpectations:Provides direct patient care service on a patient-centered care unit as determined by the patient's plan of care and supervised by a Registered Nurse. This position may require flexibility of hours.EDUCATION:High school diploma or G.E.D. equivalency.EXPERIENCE/TRAINING:One year of prior experience in clinical patient care in an acute care setting (Current CNA may be substituted for the one year experience requirement). - For Emergency Services: EMT preferred - For Women's Services: Experience in OB equivalent, Couplet Care, preferred - For Behavioral Services: Prior one year experience in acute behavioral health setting, preferred.Basic computer skills/experience with computerized documentation systems preferred.Knowledge/experience with use of medical terminology.LICENSES/CERTIFICATIONS:Required:Current Basic Life Support Provider (BLS) issued by American Heart AssociationSKILLS:Must have working knowledge of departmental equipment needed to safely & successfully perform duties. Must be able to multi-task as needed and communicate effectively and timely to team lead/RN. Must complete and maintain competency skills required by specific department/unit. Must be able to perform in a fluctuating/dynamic environment.Where applicable, performs cardiac surgery prep per infection prevention standards.Where applicable, ensures monitoring devices are managed per policy and infection prevention standards; including cardiac/telemetry, infant security.When applicable, under the direction of the RN, contributes to mobility goals, safe patient handling and use of lift/mobility equipment.Where applicable, follows clinical pathway or additional requirements for specific patient populations, including Trauma, Stroke, Bariatric, Orthopedic and Oncology.For Emergency Services: When directed by nursing/physician leaders, performs 12-lead ECGs per cardiology standards.For care of Behavioral Health population: maintains safety of self and environment to ensure patient safety.Worker Type:RegularFull timeShift:Days
Full Time
6/10/2025
Long Beach, CA 90899
(28.1 miles)
Your Role The Medical Director, National Accounts position is dedicated to supporting the promotion of growth and increased market share of the National Accounts and the Administrative Services Only (ASO) business. This includes strategic clinical and healthcare cost management guidance for the existing Blue Shield of CA book of business. This position will report directly to the VP, CMO, Commercial Markets. This position provides clinical direction to the sales team and sales processes and interacts directly with employers and consultants. This role will be at the center of driving strategy for how to reduce cost of care, while providing client advisory services, increasing engagement, and improving the quality of care & population health for our employers’ membership.Your Work In this role, you will: Lead client and producer facing activities including finalist presentations and account services meetings, broker and consultant meetings, meetings with Mercer, WTW, Aon, etc. Actively participate in and guide the preparations and the actual client meetings. Other activities include interpreting clinical data for employers at regular or pre-determined intervals, reviewing cost/spending trends, making recommendations on improving member engagement and population health. You will work diligently both internally and externally to develop, refine, and expertly communicate the BSC Clinical Value Proposition.Work collaboratively with other Healthcare Solutions and BSC staff to quickly resolve client service issues, with particular emphasis on clinical issues. Be available to talk with key account members about their issues and the solutions.Act as a strategic thought-partner for key clients (e.g. UC, Stanford, CalPERS) who want best-in-class medical, health and wellness programs.Responsible for the planning, development, and leading the delivery of Healthcare Solutions related materials to clients, producers and business associations that describe and explain the operational details and value of Healthcare Solutions capabilities, services and programs. Includes working with the Health Data Reporting teams to analyze data trends and develop external customer reports.Support other ASO Line of Business activities such as: business planning, business development, and designing and implementing innovations to address market needs.Your Knowledge and Experience Medical Degree (M.D./D.O.)Completed residency preferably in adult based primary care specialty (e.g. internal medicine, family practice)Active, unrestricted California State Medical LicenseMinimum 10 years managed care experience requiredAt least five years clinical experience requiredExperience with California managed care marketplace is requiredPrevious experience in national, complex account management support is requiredExperience supporting Administrative Services Only (ASO) lines of business is preferredPrevious experience in a similar sales role preferredPrior experience as a people manager preferredExcellent verbal and written communication skills, including ability to speak comfortably and extemporaneously to diverse audiencesAbility to explain program, clinical, operational, and quantitative information in a business-like, clear, coherent, and comprehensible wayStrong quantitative and analytic skills working with claims, operational, and clinical data and reportsExcellent interpersonal communication skills, including active listening, self-management and awareness, emotional intelligence, and ability to flex interpersonal style situationalDemonstrated ability to model a collaborative approach with internal and external stakeholdersStrong negotiation and creative problem-solving skillsStrong skills with Microsoft Office Suite, including PowerPoint, Excel, Word and Outlook
Full Time
6/6/2025
Long Beach, CA 90802
(29.5 miles)
YourRole TheCareManagement Department is seeking adedicated and compassionate Clinical Service Coordinator (CSC) to join our team.The Clinical Service Coordinatorwill report to the SupervisorofCare Operations.The CSC will play a vital role in outreach and engagement efforts with our members, introducing them to care management services, and conducting assessments to identify their needs. The successful candidate willinteract telephonically with members to assist with simple care coordination needs and facilitate connections between members and appropriate services, including internal nurse care managers, vendors, and behavioral health providers.YourWork Inthisrole,youwill:Conduct telephonic outreach efforts to engage members andintroduce them to care management services.CompletethoroughassessmentstoidentifymemberneedsandcaregapsMaintain accurateand up-to-datememberrecordsanddocumentation ofall interactions and services providedConductfollow-upcallstoensuremembers’needsarebeingmetProvide members with information and resources about available care management services and how to access themProvidesadministrative/clericalsupporttomedicalanddiseasemanagementprograms.Acts as aliaison, gathers information, and track all patients referred to the care management programs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals tocommunity resources, facilitation ofmedical services, referral to ancillary providers,etc.Assistsinverifyinghealthplanbenefitsandcoordinatingambulatoryservices.Demonstratesculturalcompetencetoworkeffectively,respectfully,andsensitivelywithin the client’s cultural context.Assistswithpreceptingresponsibilitiesfornewhiresandauditingefforts. YourKnowledgeandExperience AminimumofahighschooldiplomaAminimumof3yearsofrelevantexperienceAminimumof1yearexperienceinamanagedcareenvironment.Bi-Lingual: Must be fluent in English and SpanishHealthinsurance/managedcareexperience(Commercial,Medicare,andMedi-Cal)CommunityresourcesandadvocacyAbilitytoidentifyissuesanddevelopeffectivesolutionstomeetmembers'needsFlexibilitytoadjusttochangingcircumstancesandmemberneedsStrong verbal and written communication skills to effectively convey information to members and colleagues
Full Time
6/10/2025
Long Beach, CA 90899
(28.1 miles)
Your Role The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions.. The Clinical Services Coordinator, Advancedwill report to the Manager, Operations FCR. In this role you will assist the clinical team to ensure a timely review of facility compliance claims, including monitoring queues, assisting with administrative support to the FCR team This will includemanagement of daily inventory, assisting with researching claims, pulling medical records and answering questions sent to the FCR mailbox. The main goal of this team is to support the clinical team to ensure they have what they need in order to complete the medical necessity reviews.Your Work In this role, you will: Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemailMonitor specific queues/workstreams andgeneratespre-defined reports to identify and resolve common errorsHandle customer/provider problematic callsCheck member history for case management triageand research member eligibility/benefits and provider networksAssign initial EOA days, or triage to nurses, based on established workflowAssists with system letters, requests for information and data entry. Monitors for Medical Records Outstanding (MRO), keeps track to ensure timely receipt and filing of medical records. **Requires occasional visits to the office to collect these medical records. Provides administrative/clerical support to the FCR team.Acts as a liaison, gather information and track all patients referred to the care management programsWork with the Operations Specialist and Senior Manager on projects as assigned.Monitor specific queues/workstreams and generates pre-defined reports to identify and resolve common errors. Your Knowledge and Experience Requires a high school diploma or equivalentRequires at least 5 years of prior relevant experienceRequires health insurance/managed care experienceRequires strong computer navigation skillsRequires independent motivation and strong work ethic
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