This is a PRN positionCompetitive pay based upon years of experience and applicable certifications, with competitive shift differential!Your Calling, Close to Home and HeartAre you in pursuit of a career that's more than a job, one that aligns with your heart and community We believe in the power of creating positive change within local communities through exceptional Occupational Therapy services, empowering individuals toward independence and an improved quality of life. Envision the opportunity to profoundly impact patients' lives, providing vital care and support, and contributing to inspiring outcomes. If this resonates, you're in the right place. As an Occupational Therapist, your role thrives on recognizing the significance of small victories in driving substantial change. Utilize your specialized skills to deliver top-tier, compassionate, and personalized care to our rehabilitation patients. Embrace a supportive team environment infused with motivation and joy in their work, granting access to cutting-edge technology. Start a rewarding career with comprehensive benefits, ensuring your peace of mind and professional growth from day one. Welcome to a fulfilling career journey where your care brings lasting impact and personal fulfillment.A Glimpse into Our WorldWhether you're laying the foundation of your career or a seasoned Occupational Therapist in search of a nurturing environment to call home, we are confident you'll feel the difference the moment you join our team. Being at Encompass Health means being a part of a growing national inpatient rehabilitation leader. We take pride in our career growth opportunities and the collaborative spirit of our team members, united for the greater good of our patients. Our recognitions, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us immensely proud.Benefits That Begin With YouOur benefits are designed to support your well-being and start on day one:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Tuition reimbursement and continuous education opportunities for your professional growth.Company-matching 401(k) and employee stock purchase plans, securing your financial future.Flexible spending and health savings accounts tailored to your unique needs.A vibrant community of individuals who are passionate about what they do.Be the Occupational Therapist You've Always Aspired to BeYour impactful journey involves:Providing direct care to patients in need of occupational therapy.Guiding patients by supervising care and treatments, leading patient assessments, creating personalized care plans, and targeting and resolving patient concerns.Building meaningful relationships with patients by dedicating time to understand their physical, mental, and emotional needs for a successful recovery.Celebrating patient victories along the way. QualificationsCurrent licensure or certification required by state regulations.CPR certification.Master's Degree preferred, or Bachelor's Degree plus sufficient experience in the field.The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're looking forward to meeting you, and we truly mean that. Join our family, and let's make a positive impact together!

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

Physical Therapist - RehabWe are seeking a dedicated Physical Therapist to join our rehabilitation team. In this role, you will help patients recover from injuries or illnesses by improving their movement, reducing pain, and restoring functionality through personalized therapy programs.Key Responsibilities:Evaluate patients to assess their physical conditions and develop individualized treatment plans.Implement therapeutic exercises, manual therapy techniques, and specialized equipment to aid recovery.Educate patients and caregivers on techniques to improve mobility and prevent future injuries.Collaborate with other healthcare professionals to ensure comprehensive care for patients.Monitor patient progress and adjust treatment plans as necessary to achieve optimal outcomes.Document patient evaluations, treatments, and progress in compliance with healthcare regulations.Work Environment:Work in rehabilitation centers, hospitals, outpatient clinics, or private practices specializing in physical therapy.Engage in a dynamic, hands-on environment that requires physical activity and patient interaction.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through training and certifications.A supportive work environment focused on collaboration and innovation in patient care delivery.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation, and evaluation of the Member’s Care Plan. The Licensed Clinician, Senior will report to the Manager, Behavioral Health Utilization Management. In this role you will be working with both the Utilization and Care Management teams, who provide utilization management, telephonic triage and care management assistance to members requesting access to Applied Behavioral Analysis (ABA) benefit. This role has a primary function of utilization management for our members seeking Behavioral Health Treatment (BHT).Your Work In this role, you will: Perform prospective utilization reviews and first level determination for members using BSC evidenced based guidelines, policies and/or nationally recognized clinal criteriaReview Functional Behavioral Assessments (FBA) and Board Certified Behavior Analyst (BCBA) Assessments submitted by providers for adherence to BACB “best practice” guidelinesGather clinical information and apply the appropriate clinical criteria/guideline, policy, and clinical judgment to render coverage determination/recommendation; prepare and present cases to Medical Director (MD) for medical director oversight and necessitydeterminationDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriateAct as a liaison with caregivers, providers, and the health care community to provide information to regarding community treatment resources, mental health managed care programs, company policies and procedures, and medical necessity criteriaSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamYour Knowledge and Experience Master’s degree in psychology or a related fieldPossesses an active BCBA certificationAt least 5 years of experience as a BCBA • Expert knowledge of Applied Behavior Analysis and Autism Spectrum DisordersConsiderable knowledge of Managed Care and the different lines of businessDemonstrated ability to deliver training to varied audiences and conduct effective meetingsExperience in a managed health care environment with regards to BHT servicesAbility to identify problems and works towards problem resolution independently, seeking guidance as neededAbility to represent the health plan in a professional and knowledgeable fashionAbility to express ideas clearly in both written and oral communicationsAbility to develop, organize, analyze, and implement processes and proceduresProficiency with Microsoft applications including Word, Excel, Outlook, and TeamsEffective interpersonal skills

At Music & Arts, we provide the tools and support for you to focus on what matters most: teaching and inspiring students. With robust benefits, a commitment to innovation, and opportunities to grow your career, you’ll find a rewarding and impactful role here. We are looking for educators who are not only skilled musicians but also dedicated to empowering learners.We believe that private lessons are the building blocks to a lifelong relationship with music. Our strong commitment to music education is fundamental to our business, and we work hard to find instructors who are experts in their instrument. We take care of all the administrative work so you can do what you do best: inspire learning and creating the next generation of musicians! What You’ll Do:As a Music Teacher, you will create an engaging, supportive, and safe learning environment where students thrive. You will: Teach music lessons to students of varying ages and skill levels.Build positive relationships with students and parents through regular communication, goal-setting, and progress updates.Partner with store teams to schedule lessons and encourage student retention.Share your musical expertise to inspire students and foster their growth.Minimum Requirements: Bachelor’s Degree in Music Education, Music Performance, or equivalent experience.2 years of music teaching experience. Preferred Qualifications: Advanced degrees (Master’s or Doctoral) in Music.Professional teaching memberships or certifications.8+ years of teaching experience, especially with multiple instruments (banjo, baritone, bass clarinet, bass guitar, bassoon, cello, clarinet, flute, French horn, guitar, mandolin, oboe, percussion, piano, piccolo, saxophone, string bass, trombone, trumpet, tuba, ukulele, viola, violin, and voice). About Music & Arts Music & Arts embodies the world of creativity and music by encouraging our teammates to find their own individual sound. We strive to create lifelong musicians and make a difference in the world by enabling musicians and non-musicians alike to experience the almost indescribable happiness that comes from playing an instrument. We believe in putting our customers first, engaging with respect and integrity and fulfilling our mission with passion.The first Music & Arts was located in a small house in Bethesda, MD and run by founder Benjamin O'Brien. When Music & Arts opened its doors in 1952, we offered printed music, music lessons, dance lessons, and art supplies. Ben decided shortly after opening his business that he wanted to focus on music to better serve his customers -- a decision that remains intact to this day.Since the 1990's, Music & Arts has expanded nationwide through organic growth and a series of acquisitions and mergers with other music dealers. In 2005, Music & Arts joined forces with American Music to become the largest band and orchestra instrument retailer in the United States. Based in Frederick, MD, Music & Arts is now part of the Guitar Center enterprise and comprises 225+ retail stores, 200+ educational representatives, and 250+ affiliate locations. Why Music & Arts Here's just some of the rewards:Pay Rate: $17.27/hr Non-Teaching Rate + $10-20/hr Teaching Rate depending on background and experience.For our employees who are musicians we offer the unique opportunity of gig leave--take time off to share your music with the world and return to your job after your tour! Music & Arts offers robust benefits and perks, including Medical, Dental, Vision, 401K plus company match, mental health support, paid sick/holiday/vacation time, employee discount program, and tuition reimbursement options.The job posting is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any specific employee, which is always dependent on actual experience, education, and other factors. The pay range(s) listed are provided in compliance with state specific laws. Pay ranges may be different in other locations. Additional Information: Music & Arts is an Equal Opportunity Employer and provides fair and equal employment opportunity to all employees and applicants regardless of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected status prohibited under Federal, State, or local laws. All employment decisions are based on valid job related requirements. If you are a qualified individual with a disability or a disabled veteran and are unable or limited in your ability to use or access our website, you may request a reasonable accommodation to express interest in a specific opening. You can request reasonable accommodation by sending an email

This is a PRN positionCompetitive pay based upon years of experience and applicable certifications, with competitive shift differential!Your Calling, Close to Home and HeartAre you in pursuit of a career that's more than a job, one that aligns with your heart and community We believe in the power of creating positive change within local communities through exceptional Occupational Therapy services, empowering individuals toward independence and an improved quality of life. Envision the opportunity to profoundly impact patients' lives, providing vital care and support, and contributing to inspiring outcomes. If this resonates, you're in the right place. As an Occupational Therapist, your role thrives on recognizing the significance of small victories in driving substantial change. Utilize your specialized skills to deliver top-tier, compassionate, and personalized care to our rehabilitation patients. Embrace a supportive team environment infused with motivation and joy in their work, granting access to cutting-edge technology. Start a rewarding career with comprehensive benefits, ensuring your peace of mind and professional growth from day one. Welcome to a fulfilling career journey where your care brings lasting impact and personal fulfillment.A Glimpse into Our WorldWhether you're laying the foundation of your career or a seasoned Occupational Therapist in search of a nurturing environment to call home, we are confident you'll feel the difference the moment you join our team. Being at Encompass Health means being a part of a growing national inpatient rehabilitation leader. We take pride in our career growth opportunities and the collaborative spirit of our team members, united for the greater good of our patients. Our recognitions, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us immensely proud.Benefits That Begin With YouOur benefits are designed to support your well-being and start on day one:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Tuition reimbursement and continuous education opportunities for your professional growth.Company-matching 401(k) and employee stock purchase plans, securing your financial future.Flexible spending and health savings accounts tailored to your unique needs.A vibrant community of individuals who are passionate about what they do.Be the Occupational Therapist You've Always Aspired to BeYour impactful journey involves:Providing direct care to patients in need of occupational therapy.Guiding patients by supervising care and treatments, leading patient assessments, creating personalized care plans, and targeting and resolving patient concerns.Building meaningful relationships with patients by dedicating time to understand their physical, mental, and emotional needs for a successful recovery.Celebrating patient victories along the way. QualificationsCurrent licensure or certification required by state regulations.CPR certification.Master's Degree preferred, or Bachelor's Degree plus sufficient experience in the field.The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're looking forward to meeting you, and we truly mean that. Join our family, and let's make a positive impact together!

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

Speech-Language Pathologist - OtherWe are seeking a versatile Speech-Language Pathologist to join our team. In this role, you will assess and treat individuals with diverse communication and swallowing disorders in various settings, helping them improve their quality of life.Key Responsibilities:Evaluate patients to identify speech, language, or swallowing difficulties.Develop and implement individualized treatment plans tailored to specific needs.Provide therapy focused on articulation, fluency, voice quality, and cognitive-communication skills.Educate patients and families on strategies to support communication and swallowing improvements.Collaborate with other healthcare professionals to ensure comprehensive care.Document patient progress and adjust therapy plans as needed for optimal outcomes.Work Environment:Work in varied environments such as private practices, hospitals, or community health programs.Engage in a dynamic setting requiring adaptability and innovative problem-solving skills.Benefits:Competitive salary and comprehensive benefits package.Opportunities for professional growth through training and certifications.A supportive work environment focused on collaboration and innovation in patient care.*This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.This individual will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership. The Director, Medicare & Medi-Cal Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.Your Work In this role, you will: Manages and monitors prior authorization and concurrent review to ensure that the patient is getting the right care in a timely and cost-effective way.Leading 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 savings.Provides analysis and reports of significant utilization trends, patterns, and resource allocation.Partners with physicians and others to develop improved utilization of effective and appropriate services.Establishing and measuring productivity metrics to support workforce planning methodology and rationalization of services required to perform UM reviews.Reviewing and reporting out on Utilization Review (UR) trending for Medicare and Medi-Cal membership.Ensuring alignment of the authorization strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of care.Responsible for managing strategic projects and supporting operations initiatives.Leading operational implementation of transformation changes (organizational management, process implementation, technology adoption).Responsible for operational teams' performance, resource management, continuous improvement, and training.Responsible for operational audit readiness, ensuring adequate processes and internal audit measures in place and maintained quarterly.Ensuring all operational processes are meeting regulatory and accreditation requirements.Fosters a culture of process excellence, BSC leadership principles, and a great place to work environment.Occasional business travel required.Your Knowledge and Experience Requires current CA RN LicenseBachelor’s of Science in Nursing or advanced degree preferredMaster’s degree or equivalent experience preferredMinimum of 10 years of Utilization Management or relevant experience, including 6 years of management experienceMinimum of 5 years of progressive leadership in Utilization Management operationsHealth plan or similar health care organization structure experience requiredSuccessful track record in driving organizational change managementExcellent relationship and consensus-building skills required

This is a PRN positionCompetitive pay based upon years of experience and applicable certifications, with competitive shift differential!Your Calling, Close to Home and HeartAre you in pursuit of a career that's more than a job, one that aligns with your heart and community We believe in the power of creating positive change within local communities through exceptional Occupational Therapy services, empowering individuals toward independence and an improved quality of life. Envision the opportunity to profoundly impact patients' lives, providing vital care and support, and contributing to inspiring outcomes. If this resonates, you're in the right place. As an Occupational Therapist, your role thrives on recognizing the significance of small victories in driving substantial change. Utilize your specialized skills to deliver top-tier, compassionate, and personalized care to our rehabilitation patients. Embrace a supportive team environment infused with motivation and joy in their work, granting access to cutting-edge technology. Start a rewarding career with comprehensive benefits, ensuring your peace of mind and professional growth from day one. Welcome to a fulfilling career journey where your care brings lasting impact and personal fulfillment.A Glimpse into Our WorldWhether you're laying the foundation of your career or a seasoned Occupational Therapist in search of a nurturing environment to call home, we are confident you'll feel the difference the moment you join our team. Being at Encompass Health means being a part of a growing national inpatient rehabilitation leader. We take pride in our career growth opportunities and the collaborative spirit of our team members, united for the greater good of our patients. Our recognitions, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us immensely proud.Benefits That Begin With YouOur benefits are designed to support your well-being and start on day one:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Tuition reimbursement and continuous education opportunities for your professional growth.Company-matching 401(k) and employee stock purchase plans, securing your financial future.Flexible spending and health savings accounts tailored to your unique needs.A vibrant community of individuals who are passionate about what they do.Be the Occupational Therapist You've Always Aspired to BeYour impactful journey involves:Providing direct care to patients in need of occupational therapy.Guiding patients by supervising care and treatments, leading patient assessments, creating personalized care plans, and targeting and resolving patient concerns.Building meaningful relationships with patients by dedicating time to understand their physical, mental, and emotional needs for a successful recovery.Celebrating patient victories along the way. QualificationsCurrent licensure or certification required by state regulations.CPR certification.Master's Degree preferred, or Bachelor's Degree plus sufficient experience in the field.The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're looking forward to meeting you, and we truly mean that. Join our family, and let's make a positive impact together!

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

Physical Therapist - Home Health Join our team as a dedicated Physical Therapist in Home Health, where you will help patients improve movement, manage pain, and regain independence in the comfort of their own homes. Key Responsibilities: Review patient medical histories and conduct assessments to diagnose movement dysfunction and identify patient goals.Develop and implement individualized treatment plans that may include hands-on therapy, exercises, and use of assistive equipment.Provide skilled physical therapy services in accordance with a physician’s plan of care, adapting interventions to the home environment.Educate patients and family members about the recovery process, safe mobility, and home exercise programs.Monitor and document patient progress, modifying treatment plans as needed to achieve optimal outcomes.Communicate and collaborate with physicians, nurses, and other healthcare professionals to coordinate care.Supervise and instruct Physical Therapist Assistants or Aides as required.Ensure all documentation is completed promptly and accurately in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong communication, organizational skills, and the ability to work independently. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health physical therapy. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will support the clinicians with daily operations, provide coaching, and serve as the subject matter expert for the BH UM team as they conduct clinical reviews of mental health and substance use authorization requests at various levels of care for medical necessity.Your WorkIn this role, you will:Facilitate communication between leadership, Medical Directors, and non-clinical leads to address line staff questions and issues; escalate matters to management with recommendations or consultation as neededLead onboarding/training of incoming staff, provide proactive and guided support through the onboarding processMaintain and gain knowledge of behavioral health utilization management through team and departmental expansion as neededAct as subject matter expert to review and evaluate the effectiveness of operational workflows to identify problems and develop improvements, modifications, and enhancementsDevelop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staffAssist with audit readiness in collaboration with internal BSC partnersPerform advanced or complicated prior authorization and concurrent utilization reviews and first level determinations for members using non-profit association guidelines ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for oversight and necessity determinationIdentify process and control improvement opportunities and provide recommendations that help improve the effectiveness, efficiency and/or economic value of a control or processProvide guidance, coaching and training on internal behavioral health utilization management processes to other employees across the company as appropriateLead, manage, and execute other special projects and team initiatives as assignedLead team huddles/meetings to support processes and collaboration of team membersSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least seven (7) years of prior experience in healthcare related fieldExperience operating in a lead role or equivalent leadership training is preferredFive (5) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredDeep knowledge of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay clinical against nonprofit association guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

This is a PRN positionCompetitive pay based upon years of experience and applicable certifications, with competitive shift differential!Your Calling, Close to Home and HeartAre you in pursuit of a career that's more than a job, one that aligns with your heart and community We believe in the power of creating positive change within local communities through exceptional Occupational Therapy services, empowering individuals toward independence and an improved quality of life. Envision the opportunity to profoundly impact patients' lives, providing vital care and support, and contributing to inspiring outcomes. If this resonates, you're in the right place. As an Occupational Therapist, your role thrives on recognizing the significance of small victories in driving substantial change. Utilize your specialized skills to deliver top-tier, compassionate, and personalized care to our rehabilitation patients. Embrace a supportive team environment infused with motivation and joy in their work, granting access to cutting-edge technology. Start a rewarding career with comprehensive benefits, ensuring your peace of mind and professional growth from day one. Welcome to a fulfilling career journey where your care brings lasting impact and personal fulfillment.A Glimpse into Our WorldWhether you're laying the foundation of your career or a seasoned Occupational Therapist in search of a nurturing environment to call home, we are confident you'll feel the difference the moment you join our team. Being at Encompass Health means being a part of a growing national inpatient rehabilitation leader. We take pride in our career growth opportunities and the collaborative spirit of our team members, united for the greater good of our patients. Our recognitions, including being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, make us immensely proud.Benefits That Begin With YouOur benefits are designed to support your well-being and start on day one:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Tuition reimbursement and continuous education opportunities for your professional growth.Company-matching 401(k) and employee stock purchase plans, securing your financial future.Flexible spending and health savings accounts tailored to your unique needs.A vibrant community of individuals who are passionate about what they do.Be the Occupational Therapist You've Always Aspired to BeYour impactful journey involves:Providing direct care to patients in need of occupational therapy.Guiding patients by supervising care and treatments, leading patient assessments, creating personalized care plans, and targeting and resolving patient concerns.Building meaningful relationships with patients by dedicating time to understand their physical, mental, and emotional needs for a successful recovery.Celebrating patient victories along the way. QualificationsCurrent licensure or certification required by state regulations.CPR certification.Master's Degree preferred, or Bachelor's Degree plus sufficient experience in the field.The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're looking forward to meeting you, and we truly mean that. Join our family, and let's make a positive impact together!

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

Physical Therapist - Home Health Join our team as a dedicated Physical Therapist in Home Health, where you will help patients improve movement, manage pain, and regain independence in the comfort of their own homes. Key Responsibilities: Review patient medical histories and conduct assessments to diagnose movement dysfunction and identify patient goals.Develop and implement individualized treatment plans that may include hands-on therapy, exercises, and use of assistive equipment.Provide skilled physical therapy services in accordance with a physician’s plan of care, adapting interventions to the home environment.Educate patients and family members about the recovery process, safe mobility, and home exercise programs.Monitor and document patient progress, modifying treatment plans as needed to achieve optimal outcomes.Communicate and collaborate with physicians, nurses, and other healthcare professionals to coordinate care.Supervise and instruct Physical Therapist Assistants or Aides as required.Ensure all documentation is completed promptly and accurately in compliance with agency and regulatory standards. Work Environment: The role is based in patients’ homes, requiring travel within the community and adaptability to various home settings.This position requires strong communication, organizational skills, and the ability to work independently. Benefits: A competitive salary with opportunities for career advancement within home health or rehabilitation specialties.A comprehensive benefits package including health insurance, retirement savings plans, and paid time off.Support for continuing education programs to maintain licensure and enhance expertise in home health physical therapy. Equal Opportunity Employer: Your commitment to helping patients regain independence at home is valued here. We strive to create an inclusive environment where all employees can thrive professionally while making a meaningful difference in patients’ lives. *This information is based on the Bureau of Labor Statistics (BLS). Actual job responsibilities may vary by location.*

Your Role Reporting to the Chief Medical Officer, the Senior Medical Director, Clinical Strategy will define the vision and priorities for Blue Shield of California’s strategy to deliver best in class clinical outcomes for our members while working to ensure that health care is affordable. In this role you will be accountable for working in partnership with other leaders to deliver best in class clinical programs and align our value-based care models to meet our clinical strategy objectives. Your WorkIn this role, you will:Develop a clinical strategy framework and guiding principles, grounded in data on population health outcomes and cost, to deliver Best in Class clinical outcomes for Blue Shield of California membersDefine the organization’s overall clinical strategy, as relates to priorities, partnerships, and key measures of success to improve member experience, population health and affordability, inclusive of primary care and specialty careCo-chair the Clinical Program Review and Governance Committee with the Chief Medical Officer to ensure that all clinical programs are delivering expected clinical and cost of care outcomes for our membersWork with teams performing vendor management to ensure that contracts include appropriate metrics to ensure programs are meeting operational targets to achieve clinical objectivesCollaborate with the Health Economics team to develop the methodology to evaluate the effectiveness and lead a process to ensure robust evaluation of all clinical programsCollaborate with business leaders to ensure that the clinical strategy and clinical programs are meeting business, client, and member needsCreate an environment of accountability and continuous quality improvement to ensure that all clinical programs continue to meet and exceed objectives necessary to deliver best in class clinical outcomes for Blue Shield of California membersCommunicate internally and externally the vision and strategy to transform healthcare to deliver Best in Class clinical outcomes for Blue Shield of California membersYour Knowledge and ExperienceMinimum of 2 years of previous medical leadership experienceMinimum of 5 years of direct patient care experience post residencyMinimum 4 years experience in observational study design and execution and/or clinical program evaluationMedical degree (M.D./D.O.)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 requiredOutstanding verbal and written communication skillsAbility to lead through influence in a matrixed organizationMasters or PhD in Health Services Research, Epidemiology, Biostatistics or similar field preferredExperience in a health plan or managed care organization is preferred

Extra attention to detail Exceptional outcomes This is a PRN position BE THE CONNECTION.Your role as a certified occupational therapy assistant (COTA) lets you be the connection between dedication to detail and patient outcomes that exceed expectations. Use your passion for rehabilitation to ensure that patients receive care that sets the standard as you treat patients with compassion and empathy. Enhance the impact of your abilities with national post-acute care leader Encompass Health. What Makes Encompass Health Careers Different-and Better:Working at Encompass Health means being part of something special: A team that is passionate about making an impact on patients' lives each day. Unlike the typical hospital setting, Encompass Health offers you the unique opportunity to walk alongside patients on their road to recovery from stroke, spinal cord injuries, neurological disorders, joint replacements, multiple trauma and cardiac/pulmonary conditions. As you help patients achieve goals and regain independence, you can form significant relationships with them and celebrate the successes they experience along the way.Our culture of compassion and collaboration is founded on more than just the care we provide our patients; it is expressed in the values we live. We encourage and empower each employee to keep learning and growing by providing the resources to deliver a better way to care. At Encompass Health, you'll find something decidedly different and more satisfying: A career that is challenging, inspiring and rewarding. Maximize your talent and join a team that is committed to setting the standard for better healthcare with this engaging opportunity: CERTIFIED OCCUPATIONAL THERAPY ASSISTANT (COTA)Here is your opportunity to channel the full extent of your knowledge, skills, ambition, and experience on a daily basis. Inspire our patients to progress each day as you:• Provide occupational therapy treatment and patient care according to hospital, state and federal regulations and professional guidelines.• Perform occupational therapy treatment tasks as delegated and supervised by occupational therapists.• Maintain open and ongoing communication with hospital departments to ensure that patient, staff and hospital needs are met. Credentials:• Current state licensure or certification or state practice act, whichever is applicable, required.• CPR certification preferred, unless otherwise required by hospital policy.• Successful completion of an associate's degree from an accredited occupational therapy assistant program preferred.• Effective communication skills for working with patients, families and caregivers required.• Demonstrated competency in occupational treatment essential. Enjoy competitive compensation and benefits that start on day one, including: • Benefits that begin when you do.• Affordable medical, dental and vision plans provided to meet the needs of full and part-time employees and their families.• Generous paid time off that increases with tenure.• Tuition reimbursement and continuing education opportunities.• Company-matching 401(k) and employee stock-purchase plans.• Flexible spending and health savings accounts. About Us:Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals and offer home health and hospice care in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together. Realize the powerful difference you can make. Take this opportunity to join our team.To learn more about us, please visit us online at encompasshealth.com Connect with us:Equal Opportunity Employer QualificationsCompensation: $45.00 an hour

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

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.

Event DetailsJoin us for an Interview and Hiring Day! Registered Nurses welcomed!Location:1680 E. 120th Street, Los Angeles, California 90059Date: Tuesday, June 24thTime: 9:00 am to 3:00 pmDirections/Parking: Our main lobby entrance is located at 1680 E 120th Street, Los Angeles, CA 90059. The entrance to the parking lot is on Healthy Way at the north side of our building, behind the large sculpture. Our hospital is easily accessible by public transportation and car.Click RSVPNow to get startedThis event is for experienced Registered Nurses*Nurse Residents please send your resume for consideration for our next cohort opening September 2025, please review our website for dates. Here's why it's great to be a nurse at MLKCHMLK Community Healthcare has a culture of nursing like no other. We have a compelling mission to improve the health of an appreciative and truly deserving community. We support our nurses with tools, training and best-in-class resources. Our fantastic new RN Residency Program launches recent graduates on a path to success. Our staff fellowships for experienced nurses open doors to new fields of expertise and leadership training at the highest level. And we offer competitive pay and unbeatable benefits. The result Inspirational careers and the chance to make a meaningful difference in the lives of the most vulnerable.

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

Physical Therapist Assistant Career Opportunity Join a Team That Puts Your Passion for Care FirstAre you on the lookout for a fulfilling career that not only feels like home but also allows you to make a meaningful impact close to your heart Join us as a Physical Therapist Assistant and contribute to the remarkable progress and inspiring outcomes of our patients. Embrace the opportunity to deliver high- quality, compassionate, and personalized care, celebrating the small successes that lead to significant achievements in rehabilitation. Our well-equipped physical therapy gyms, driven team members, and supportive environment create an atmosphere where you can thrive. A Glimpse into Our WorldAt Encompass Health, you'll experience the difference the moment you become a part of our team. Being associated with us means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing. Starting Perks and BenefitsAt Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to:Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.Generous paid time off that accrues over time.Opportunities for tuition reimbursement and continuous education.Company-matching 401(k) and employee stock purchase plans.Flexible spending and health savings accounts.A vibrant community of individuals passionate about the work they do!Be the Physical Therapist Assistant you always wanted to beChannel your expertise, ambition, and experience into making a difference every day:Provide top-notch physical therapy treatment in compliance with regulations and professional guidelines.Execute delegated physical therapy assistant tasks under supervision, supporting patients' progress.Maintain transparent communication across hospital departments to meet patient and staff needs effectively.QualificationsState licensure or certification required.CPR certification preferred (as per hospital policy).Completion of an accredited physical therapy program preferred.Demonstrated competence in physical therapy treatment.Strong communication skills for patient, family, and caregiver interactions. The Encompass Health WayWe proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.We're eager to meet you, and we truly mean that. Join our family and let's make a difference together!

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

Your Role The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation, and evaluation of the Member’s Care Plan. The Licensed Clinician, Senior will report to the Manager, Behavioral Health Utilization Management. In this role you will be working with both the Utilization and Care Management teams, who provide utilization management, telephonic triage and care management assistance to members requesting access to Applied Behavioral Analysis (ABA) benefit. This role has a primary function of utilization management for our members seeking Behavioral Health Treatment (BHT).Your WorkIn this role, you will:Perform prospective utilization reviews and first level determination for members using BSC evidenced based guidelines, policies and/or nationally recognized clinal criteriaReview Functional Behavioral Assessments (FBA) and Board Certified Behavior Analyst (BCBA) Assessments submitted by providers for adherence to BACB “best practice” guidelinesGather clinical information and apply the appropriate clinical criteria/guideline, policy, and clinical judgment to render coverage determination/recommendation; prepare and present cases to Medical Director (MD) for medical director oversight and necessitydeterminationDevelop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriateAct as a liaison with caregivers, providers, and the health care community to provide information to regarding community treatment resources, mental health managed care programs, company policies and procedures, and medical necessity criteriaSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamYour Knowledge and Experience Master’s degree in psychology or a related fieldPossesses an active BCBA certificationAt least 5 years of experience as a BCBAExpert knowledge of Applied Behavior Analysis and Autism Spectrum DisordersConsiderable knowledge of Medi-Cal Managed CareDemonstrated ability to deliver training to varied audiences and conduct effective meetingsExperience in a managed health care environment with regards to BHT servicesAbility to identify problems and works towards problem resolution independently, seeking guidance as neededAbility to represent the health plan in a professional and knowledgeable fashionAbility to express ideas clearly in both written and oral communicationsAbility to develop, organize, analyze, and implement processes and proceduresProficiency with Microsoft applications including Word, Excel, Outlook, and TeamsEffective interpersonal skills

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

Your Role The Network Contracting and Trend Analytics (NTA) team supports the Network Management team with analytical and financial modeling for provider contracting and network development activities for Blue Shield of California. The Senior Principal, Medical Informatics of NTA will report to the Senior Director of NTA. In this role you will be responsible for behavioral health finance analytics including measurement of internal cost of healthcare and reporting, analytics supporting coordination of care opportunities, and oversight of provider contracting analytics. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your Work In this role, you will: Develop the financial management and modeling best practices, specifically for Behavior Health as we move to an in-sourced environmentImplement on-going behavior health costs analysis and trendsBe responsible for CoHC - Behavior HealthBe the lead on modeling the financial aspects. Example, evaluating the financial aspects of care activities such as hospital ER vs behavioral health servicesLead all financial aspects in developing Value-Based Contracting, specifically in Behavior Health marketplace.Be accountable for development of the financial contractual arrangements and the implementation of these providers, which we are bringing in house Your Knowledge and Experience Requires a college degree or equivalent experienceMPH, MBA, MS, MA, RN, or RHIA preferredRequires 10 years of relative experienceRequires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer)Requires contracting in healthcare with a behavioral health specialtyRequires experience developing programs that will translate into CoHC savings specifically in extensive vendor knowledge of financial healthcare within behavioral healthRequires experience with behavioral health financial reporting and modelingRequires one to be comfortable with an ever changing business model that is continually seeking the optimal solution in the behavioral health spaceRequires a SAS Certified Base Programmer Credential or equivalent or a SAS Certified Advanced Programmer Credential or equivalent