SOUTHERN CALIFORNIA PHYSICIANS MANAGED CARE SERVICES CURRENT CAREER OPENINGS (As of October 22, 2024)

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
• Client Services Representative (Bilingual English/Spanish)
• Outpatient Case Manager (RN)

Administrative Assistant

Department:	Administration
Level:	Non-supervisory
Reports To:	Chief Executive Officer
Private Health Information (PHI):	Position requires access to PHI, including “read only” access to eligibility, claims and authorizations.
Job Classification:	Non-Exempt
Job Type:	Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate:	$23.82 - $29.19 an hour. Salary is based on qualifications and experience
Position Summary:	The Executive Assistant provides high-level administrative support to senior executives within the organization. This role involves the coordination and management of executive schedules, handling of communication, compilation of and uploading of information to the OPTUM corporate offices. The role also includes some minor mailroom duties and performing a variety of tasks that ensure the efficient operation of the office. Other duties as assigned.
Essential Job Functions:	Calendar Management - Assists the Executive Staff (and Directors as requested) with scheduling and responding to external meeting requests. Arranges internal meetings as requested. As requested, assists with set-up for luncheon/dinner meetings. Assists with the preparation of presentations (including PowerPoint), collects requested documents, prepares contracts for signature, transfers the foregoing to the applicable receiver via mail or email or system upload. Electronically files as appropriate. Drafts/types correspondence as requested. This includes letters, mail merges, forms, policies and procedures. Mailroom Support - On a daily basis, scans paper claims to Calibrated; mails claims checks and mails other ad hoc mail. Sorts incoming mail and distributes to the appropriate department(s). Communication - Act as the point of contact between executives, internal staff, and external stakeholders. Screen and prioritize communications, including emails, phone calls, and requests. Project Management - Support special projects as needed, ensuring timely completion and quality results. 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.
Position Qualifications and Requirements:	3 - 5 years of experience as an Executive Assistant, Administrative Assistant, or similar role. Strong organizational and multitasking skills. Excellent verbal and written communication skills. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). Ability to work independently and as part of a team. High attention to detail and problem-solving skills. Discretion and confidentiality. Must have the ability to network effectively with a wide variety of people and organizations. Demonstrated professional office demeanor. Other duties as assigned.
Education/Course(s) /Training:	Bachelor’s degree in Business Administration, Management, or a related field (or equivalent experience).
Licensure/Certification:	N/A
Location:	Mira Mesa, San Diego
Date Posted:	October 22, 2024
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

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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. 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:	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 required.
Licensure/Certification:	N/A
Location:	Mira Mesa, San Diego
Date Posted:	October 22, 2024
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

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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. 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:	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:	October 22, 2024
	To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

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