SCPMCS - About SCPMCS - Career Opportunities

SOUTHERN CALIFORNIA PHYSICIANS MANAGED CARE SERVICES CURRENT CAREER OPENINGS (As of May 25, 2023)

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:

Administrative Assistant

Department:	Network Management
Level:	Non-supervisory
Reports To:	Director, Network Management
Private Health Information (PHI):	Position requires "read only" access to member authorizations and "read and write" access to member claims and eligibility.
Job Classification:	Non-Exempt
Job Type:	Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate:	$19.69 - $24.12 an hour
Position Summary:	Provides administrative support to the Senior Team by performing a variety of functions including, but not limited to, arranging internal and external meetings/conferences; answering the telephone and taking messages; assisting callers and visitors; drafting presentations; generating reports, rosters and other communications such as contract documents, minutes, forms, directories, correspondence, policies and other projects/duties as assigned.
Essential Job Functions:	Telephone/Messages – Answers the telephone on behalf of the Executive Staff in a courteous and professional manner, accurately takes messages and /or refers the caller to the appropriate staff person. Arranging meetings/conferences – Makes appointments, and processes conference registrations as requested. Communicates and confirms meetings with the parties involved in their preferred format. Coordinates the internal conference room availability, catering, set-up and break-down. Participates in meetings as needed. Contract Preparation/Tracking/Distribution – under the supervision of the Director of Network Management, prepares appropriate documents including rates, language and amendments using standard templates. Tracks the contracting process from inception through execution. Summarizes and distributes executed contracts to internal departments following contract guidelines. Negotiates and prepares ad hoc agreements. Record keeping – Maintains logs, files and generates reports/rosters as requested. Assists with data maintenance required to generate accurate reports/rosters. Participates in Contact Wise development. Correspondence - Drafts and/or types of correspondence as requested. This includes letters, mail merges, minutes, forms, policies. Drafts Power Point presentations, modifies Provider Manuals and supports other marketing activities as requested. Follows company formats consistently and ensures accurate information, appropriate tone and language is used. Copies, faxes and mails information timely and accurately as requested. Files - Maintains executive and provider files efficiently and accurately. Performs other duties as assigned.
Position Qualifications and Requirements:	Previous assistant/administrative secretarial experience. Strong customer service and professional communication skills, both written and verbal, required. Must have the ability to network effectively with a wide variety of people and organizations. Excellent organizational and time management skills and ability to handle multiple tasks. Proficient in word processing, spreadsheets, graphics programs, Excel, PowerPoint and Word. Demonstrated ability to handle confidential or sensitive issues in a responsible manner. Demonstrated professional office demeanor.
Education/Course(s) /Training:	High school diploma required. Office related education. Bachelor’s Degree preferred.
Licensure/Certification:	N/A
Location:	Mira Mesa, San Diego
Date Posted:	May 25, 2023
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

Client Services Representative (Bilingual English/Spanish)

Department:	Network Management
Level:	Non-supervisory
Reports To:	Director, Network Management
Private Health Information (PHI):	Position requires "read only" access to member authorizations, claims and eligibility. "Write" access to member notes only.
Job Classification:	Non-Exempt
Job Type:	Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate:	$17.90 - $21.92 an hour
Position Summary:	Provides internal and external clients with information related to managed care services; such as Utilization Management, Claims Processing, IPA Management, Eligibility and Contracting.
Essential Job Functions:	Initiates and coordinates resolution of inquiries from both internal and external clients. Obtains appropriate data to research issues, including but not limited to medical records, claim/authorizations copies and other contributing information. Provides clients with immediate status of authorizations, claims processed, eligibility, physician availability and demographic information. Processes and researches client issues via EZCAP System. Enters member notes on all issues requiring additional action. Responds to clients via phone, e-mail, fax or letter on issues that cannot be resolved during the course of the initial phone contact. Cross-trains into other Network Management positions as needed, performs other duties as assigned.
Position Qualifications and Requirements:	Two years experience in a healthcare setting One year experience working in a customer service/call center environment Ability to answer a minimum of 70 calls per day Ability to type a minimum of 40 wpm Excellent communications skills Basic knowledge of Microsoft Office Products Knowledge of CPT, ICD-10 codes desired Knowledge of basic managed care principles and processes desired Bilingual in Spanish a plus
Education/Course(s) /Training:	High School Diploma
Licensure/Certification:	NA
Location:	Mira Mesa, San Diego
Date Posted:	May 25, 2023
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

Information Technology (IT) / Claims Assistant

Department:	Information Technology / Claims
Level:	Non-supervisory
Reports To:	Production & Eligibility Manager
Private Health Information (PHI):	Position requires "read only" access to member authorizations, claims and eligibility.
Job Classification:	Non-Exempt
Job Type:	Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate:	$19.69 - $24.21 an hour
Position Summary:	IT - Responsible for assisting the Data Management Specialist with inbound and outbound (EDI) electronic data exchange. Provides telephone training, registration and support for Web site users. Perform administrative and clerical duties for the IT department. Provide entry level hardware/software troubleshooting along with onboarding and offboarding of employees. Claims - Assists the Claims Department staff by sorting & distributing daily forms and letters, pulling manual claims, and distributing incoming faxes. Handles mail room functions, including sorting and posting mail, scanning, and folding letters, and forwarding misdirected claims. Assists with pulling claims for audits.
Essential Job Functions:	IT Responsibilities: Retrieves and distributes EDI data files from health plan websites and FTP. Submits outbound electronic medical claims to health plans and clearinghouses. Creates user accounts for new SCPMCS employees on requested health plan websites. Accurately update spreadsheet for Data Management Specialist who creates the Secure login function and trains the users. Provides Web site user support including password reset, new user profile setup, and new user telephone-based training Reports all security, privacy, and procedure breaches to the Director of Information Technology immediately. Manage printer supplies and repair requests. Performs other duties as assigned, including regular and temporary teams as assigned by the Director of Information Technology. Basic PC hardware/software troubleshooting. Onboarding/offboarding of new employees. Claims Responsibilities: Prepares requested documents for health plan audits. Sorts and operates folding machine for all outgoing letters and checks. Compiles misdirected claims. Prints misdirected claims and mails them to appropriate health plan. Applies postage to all outgoing mail. Sorts and distributes incoming mail. Distributes incoming fax emails. Keeps mailroom clean and stocked. Refills the copier and fax machine with paper as required. Other duties as assigned.
Position Qualifications and Requirements:	Proven experience supporting multiple electronic environments for data exchange with trading partners in both batch and interactive environments including the Web and FTP. Should be familiar with and have experience with EDI formats, multiple protocols, preferably in a medical transaction environment. Working knowledge of MS Office, Excel and Word, Access a plus Proven ability to work with multiple projects with internal personnel and trading partners in a professional manner. Excellent interpersonal skills are essential. Proven organizational skills with attention to detail and the ability to prioritize work. Strong written and verbal communication skills. Must have an excellent disposition/attitude and ability to multi-task. Must be authorized to work in the USA Must be able to speak/read/write English. Must be able to occasionally work evenings and weekends as needed. Minimum two years clerical experience. Ability to compose letters with emphasis on correct grammar, punctuation, etc. Experience in supporting IT is a plus.
Education/Course(s) /Training:	Associate degree in Information Systems or Business Administration or equivalent experience required, Bachelor's preferred.
Licensure/Certification:	N/A
Location:	Mira Mesa, San Diego
Date Posted:	May 25, 2023
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

Performance Improvement Manager

Department:	Network Management
Level:	Supervisory
Reports To:	Director, Network Management
Private Health Information (PHI):	Position requires access to PHI, including "read only" access to eligibility, claims and authorizations. "Write" access to member notes and provider notes.
Job Classification:	Exempt
Job Type:	Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate:	$36.68 - $46.95 an hour
Position Summary:	Provide leadership and operational management for quality and risk programs across the provider network. Supervises the daily activities of the performance team. Develops and implements quality improvement initiatives. Collaborates with internal departments and health plans to ensure compliance with IHA, HEDIS and CMS Stars initiatives. Responsible for annual quality data reporting and the audit process. Oversees the annual assessment program to ensure accurate documentation.
Essential Job Functions:	Reporting – Monitor IPA performance and staff productivity. Analyze data to measure program effectiveness. Programs – Develop and monitor initiatives for ongoing IPA improvement. Create tools and materials for training and performance monitoring. Client Relations – Works with the Director of Network Management to maintain positive and productive relationships between department staff, health plans, providers and members. Works with Provider Relations team to communicate with physicians and their staff. Meet with physicians as needed. Staff Supervision – Supervises the daily activities of the performance staff, employee work schedules and work assignment to ensure effective business operations. Takes appropriate corrective action when required to improve employee performance in accordance with policy. Participates in the interviewing and hiring of new staff. Provides staff training as required. Represents the MSO in state/regional meetings and conferences specific to quality. Including but not limited to IHA, health plans, IPA meetings, vendor user conferences. Performs other duties as assigned.
Position Qualifications and Requirements:	Prior supervisory experience managing diverse areas of responsibility. Minimum of 3 years of operations experience in a health plan, MSO or medical group environment and have a working knowledge of managed care principles. Prior Quality Improvement experience. Knowledge of regulatory requirements related to quality programs including NCQA’s HEDIS, Medicare STARS and the Integrated Healthcare Assoc. AMP program. Strong customer service and professional communication skills, both written and verbal, required. Excellent organizational and time management skills. Ability to work on multiple complex projects simultaneously. Advanced knowledge of Microsoft Word, Excel, email and intermediate knowledge of PowerPoint, Access and other applications/information system pertinent to managing data and conducting training sessions. Experience in data analysis. Familiar with claims processes, CPT, ICD-10 and HCPCS coding desired. Certificate in coding is a plus
Education/Course(s) /Training:	Bachelor’s Degree in health care administration, public health, nursing, or other related field or equivalent work experience required.
Licensure/Certification:	Reliable transportation, a valid CA Driver’s License, and current car insurance meeting CA standards.
Location:	Mira Mesa, San Diego
Date Posted:	May 25, 2023
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

Outpatient Case Manager - RN

Department:	Medical Management
Level:	Non-supervisory
Reports To:	Manager, Utilization 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:	$42.20 - $51.71 an hour
Position Summary:	Reviews contracted Medical Group’s referral requests for medical necessity, determines which requests need Medical Director review, obtains sufficient medical documentation for an informed decision. Processes all requests within established timeframes. Documents all steps of process in authorization system, utilizes industry standard denial language for denial letters.
Essential Job Functions:	Reviews contracted Medical Group’s referral requests for medical necessity. Consideration is given to the appropriateness of the setting, place of service, health plan’s benefits and criteria of the requested services and utilizing contracted providers. Documents process in authorization notes. Refers all medical necessity denials to the physician reviewers for review determination. Processes denials within established time frames. Documents in the authorization system the denial reason, utilizing the industry standard denial letter language, outlines alternative services available. Reviews requests within established time frames for urgent, routine and retro requests to maintain compliance with legislative and accreditation standards. Obtains additional information for Medical Director’s review of appeals. Coordinates with health plan to meet time frames for expedited appeals. Contacts out of network or tertiary facilities for clinical information on patients authorized for services at the facility. Coordinates discharge needs for these members with hospital case manager. Notifies health plan representative of potential transplants, out of area second opinions, experimental or investigatory requests.
Position Qualifications and Requirements:	Experience/Specialized Skills: Prior experience in utilization management in a managed care environment. Proficient with computer, Microsoft Windows environment.
Education/Course(s) /Training:	Registered Nurse
Licensure/Certification:	Registered Nurse, active California License.
Location:	Mira Mesa, San Diego
Date Posted:	May 25, 2023
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org