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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: |
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Position Qualifications and Requirements: |
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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 |
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: |
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Position Qualifications and Requirements: |
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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 |
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: Claims Responsibilities: |
Position Qualifications and Requirements: |
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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 |
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: |
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Position Qualifications and Requirements: |
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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 |
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: |
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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 |