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SOUTHERN CALIFORNIA PHYSICIANS MANAGED CARE SERVICES
CURRENT CAREER OPENINGS (As of March 7, 2019)


Southern California Physicians Managed Care Services is San Diego's premier provider of medical administrative services including claims payment, contracting and utilization management.

Current Career Opportunities:

Southern California Physicians Managed Care Services has the following career opportunities available:

Inpatient/SNF Case Manager

Department: Medical Management
Level: Non-supervisory
Reports To: Director, Medical Management
Private Health Information (PHI): Position requires "read and write" access to member authorizations, "read only" access to claims and eligibility
Job Classification: Non-Exempt
Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate: Salary is based on qualifications and experience
Position Summary: Under the supervision of the Director of Medical Management, the Inpatient/SNF Case manager reviews Medical Group’s inpatients, rehab, long term acute (LTAC), and skilled nursing admissions on a concurrent basis for medical necessity. Reviews ongoing stays for continuing care criteria being met. Coordinates discharge plans with the facility’s case managers for timely discharge.
Essential Job Functions:
  • Reviews the Medical Group's inpatients on a concurrent basis for medical ecessity. Consideration is given to appropriateness of the setting, intensity and severity of services being provided and the member's benefits. Documents the review in the authorization system daily. Utilizes hospital medical record systems for on-line information.
  • Reviews all long-term acute care and skilled nursing admissions for appropriateness of the admission and ongoing for continuing care criteria being met.
  • Coordinates discharge plans with hospital or skilled nursing case managers for timely discharge or transfer to lower level of care.
  • Issues Notice of Medicare Non-Coverage to all rehab level of care and senior skilled nursing members prior to discharge. Issues exhaustion of benefits letters. Issues authorizations for post-discharge services.
  • Contacts out of network facilities for clinical information for any medical Group's member admitted to the facility. Coordinates transfer to contracted facility as appropriate.
  • Discusses the medical necessity of continued stay with the attending physician or the Medical Director when level of care appears to be inappropriate or member does not meet criteria. Issues hospital denial for members not meeting acute level of care.
  • Position Qualifications and Requirements:
  • Experience/Specialized Skills: Prior experience in utilization management or discharge planning in a managed care environment. Proficient with computer, Microsoft Windows environment.
  • Education/Course(s)/Training: Registered Nurse
  • Licensure/Certification: Registered Nurse, active California License. Must have reliable transportation, valid California Driver's License and proof of insurance.
  • Location: Mira Mesa, San Diego
    Date Posted: March 7, 2019
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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    Utilization Management Representative

    Department: Medical Management
    Level: Non-supervisory
    Reports To: Director, Medical Management
    Private Health Information (PHI): Position requires "read and write" access to member authorizations, "read only" access to claims and eligibility
    Job Classification: Non-Exempt
    Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
    Pay Rate: Salary is based on qualifications and experience
    Position Summary: Under the supervision of the Director of Medical Management, the Utilization Management Representative will perform data entry of referral requests. The Utilization Management Representative will contact Health Plans for medical policies or benefit interpretations and contact physician offices to obtain additional clinical information.
    Essential Job Functions:
  • Performs data entry of referral request images accurately on a daily basis to meet turnaround time standards.
  • Contacts Health Plans for medical policies or benefit interpretations.
  • Contacts physician offices as directed by Case Manger to obtain additional clinical information. Issues pended letter if information is not received within established timeframes.
  • Works Status 7 (Requested) Referrals daily, checking benefits as applicable, changing status to N (Nurse Review) to facilitate timely referral processing.
  • Sorts and distributes faxed referral images into designated employee folders on a rotating shared sorting schedule. Attaches electronic faxed medical record images to EZ-Cap authorization.
  • Attaches copy of pre-service denial letter to denied referral with supporting documentation.
  • Notifies requesting physician by telephone or fax within four hours of all urgent request decisions, if directed by Outpatient Case Manager.
  • Position Qualifications and Requirements:
  • Experience/Specialized Skills:
        o Knowledge of medical terminology, ICD and CPT coding.
        o Proficient with computer, Microsoft Windows environment.
  • Education/Course(s)/Training: High School Diploma
  • Licensure/Certification: N/A
  • Location: Mira Mesa, San Diego
    Date Posted: March 7, 2019
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org


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