![]() |
![]() | ||||
![]() |
![]() |
![]() |
![]() | ||
![]() |
![]() |
![]() | |||
![]() |
![]() | ||||
![]() |
![]() | ||||
|
![]() | ||||
![]() |
![]() | ||||
![]() |
![]() | ||||
![]() |
![]() | ||||
![]() |
![]() |
![]() | |||
![]() |
![]() | ||||
![]() |
![]() | ||||
|
![]() | ||||
![]() |
![]() |
![]() |
![]() |
![]() |
Department: | Claims |
Level: | Non-Supervisory |
Reports To: | Manager, Claims & Eligibility |
Private Health Information (PHI): | Position requires read and write access to member claims and read only access to member eligibility and authorizations. |
Job Classification: | Non-Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $21.66 - $26.53 an hour. Salary is based on qualifications and experience. |
Position Summary: |
These duties are split over four Auditor positions. Claims Auditors are responsible for the auditing of provider disputes, member denial letter requests, and daily prelag reports. Responsible for ensuring provider dispute and member denial letters are accurately handled. Responsible for notifying management of any compliance concerns with timeliness of claims payments. Reviewing and resolving HPIs and member OOP.
This position is primary focus on reviewing member out of pocket max notices and process corrections to member OOP as needed. Reviewing & processing member copay corrections. Position will also focus on check run reviews, including working all pre/post check run audit reports to ensure claims payments are accurate. |
Essential Job Functions: |
|
Position Qualifications and Requirements: |
|
Education/Course(s) /Training: | High School Diploma required. |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
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. Salary is based on qualifications and experience. |
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: |
|
Position Qualifications and Requirements: |
|
Education/Course(s) /Training: | High School Diploma required. |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Medical Management |
Level: | Non-Supervisory |
Reports To: | Director, Medical Management |
Private Health Information (PHI): | Position requires "read and write" access to member authorizations and "read only" access to member claims and eligibility. |
Job Classification: | Non-Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $42.20 - $56.46 an hour. Salary is based on qualifications and experience. |
Position Summary: | Supports and facilitates the delegation processes across product lines by assisting with delegation oversight audits with the health plans. Ensuring policies/procedures, documentation and reports are in compliance with regulatory and applicable accreditation guidelines, and are meeting required standards. |
Essential Job Functions: |
|
Position Qualifications and Requirements: |
Experience/Specialized Skills:: |
Education/Course(s) /Training: | Registered Nurse |
Licensure/Certification: | Registered Nurse, active California License. |
Location: | Mira Mesa, San Diego |
Date Posted: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Information Technology |
Level: | Non-Supervisory |
Reports To: | Director of Information Technology and Security |
Private Health Information (PHI): | Position has complete access to electronic PHI. |
Job Classification: | Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $33.47 – $42.68 an hour. Salary is based on qualifications and experience. |
Position Summary: | Responsible for ensuring that HIPPA compliant formats and best practices are used for electronic data exchange throughout the organization by monitoring and managing the performance of all systems and monitoring adherence to all related policies and procedures. |
Essential Job Functions: |
This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its' employees will need to assume other "non-essential functions" not listed herein which support company business objectives. This may include duties which fall outside of normal position scope.
|
Position Qualifications and Requirements: |
Experience/Specialized Skills:: |
Education/Course(s) /Training: | • Bachelor’s Degree in Information Systems or Business Administration preferred. Network Administration, Desktop Support and Database Administration a plus. |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Medical Management |
Level: | Senior Team |
Reports To: | Chief Executive Officer |
Private Health Information (PHI): | Position requires "read and write" access to member authorizations, "read only" access to claims and eligibility. |
Job Classification: | Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $63.49 - $83.18 an hour. Salary is based on qualifications and experience. |
Position Summary: | Ensure quality health care services are provided to our clients and members, providing oversight to the quality management, utilization management and credentialing functions of the organization. |
Essential Job Functions: |
|
Position Qualifications and Requirements: |
Experience/Specialized Skills:: |
Education/Course(s) /Training: | • Bachelor of Science Degree, Master’s Level preferred. |
Licensure/Certification: | Current unrestricted California Registered Nurse licensure. Reliable transportation, valid California Driver’s license and proof of insurance. |
Location: | Mira Mesa, San Diego |
Date Posted: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
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. Salary is based on qualifications and experience. |
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: |
|
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: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Network Management |
Level: | Non-Supervisory |
Reports To: | Director, Network Management |
Private Health Information (PHI): | Position requires "read only" access to member eligibility, claims, and authorizations, "read and write" access to member notes and provider notes. |
Job Classification: | Non-Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $27.89 - $35.27 an hour. Salary is based on qualifications and experience. |
Position Summary: | Primary liaison between the client and MSO for the delivery of Managed Care Administrative Services. Responsible for concise and complete explanations of all phases of services from each MSO Department to the assigned IPA groups and resolving issues between them. |
Essential Job Functions: |
|
Position Qualifications and Requirements: |
|
Education/Course(s) /Training: | Associates Degree required with a combination of related experience and training. Bachelor’s Degree preferred. |
Licensure/Certification: | N/A |
Location: | Mira Mesa, San Diego |
Date Posted: | June 10, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |
Department: | Medical Management |
Level: | Supervisory/Management |
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: | Exempt |
Job Type: | Full time - Four-Day 10 hour days, Monday - Thursday |
Pay Rate: | $48.26 - $62.50 an hour. Salary is based on qualifications and experience |
Position Summary: | Provides daily supervision to case managers and support staff. Assists with orientation and training of new staff. Documents employee discussions and disciplinary actions when appropriate. |
Essential Job Functions: |
|
Position Qualifications and Requirements: |
|
Education/Course(s) /Training: | Bachelor’s Degree, Registered Nurse |
Licensure/Certification: | Registered Nurse, active California License. Reliable transportation, valid California Driver’s License and proof of insurance. |
Location: | Mira Mesa, San Diego |
Date Posted: | July 11, 2024 |
To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org |