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Bilingual (English/Spanish) Community Relations & Outreach Specialist (Whittier Resource Center East Los Angeles) (1105230) Position Purpose Assist in the planning, implementation and evaluation of the Whittier Resource Center programs. Conduct member outreach and arrange for member education programs in the Whittier Resource Center, including coordination and creation of member materials Assist i
Posted 2 days ago
Health Net
- Huntington Beach, CA
Program Coordinator I (1104644) Position Purpose Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verify
Posted 7 days ago
Handle inbound and outbound member and provider calls on a clinical phone queue. Ensure members receive behavioral health services appropriate to clinical need. Triage crisis calls to assist with stabilization and access to emergency evaluation. Coordinate services with other departments, such as medical case/care management. Perform utilization management functions, including authorization determ
Posted 8 days ago
Diversity & Disability Program Specialist (1102247) Position Purpose Develop, implement, and evaluate a language assistance compliance monitoring system for the Plan and provider network, including hospitals and pharmacies, in accordance with contract requirements and regulations. Ensure the delivery of language and disability access services, including processing of translation requests and evalu
Posted 16 days ago
Enrollment & Retention Representative (SHP) (1103318) Position Purpose The Enrollment and Retention Representative supports the education and enrollment of prospective Health Net Medicaid members statewide by providing benefit, eligibility and Health Net information and assistance for multiple Health Net State Health Program products. The Rep gives education presentations over the telephone that m
Posted 17 days ago
Care Manager II Social Worker (Woodland Hills/San Diego CA) (1099977) Position Purpose Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals an
Posted 1 month ago
Administrative Assistant III (1098722) Position Purpose Provides administrative and staff support to an organizational unit. Schedules appointments and travel arrangements, gives information to callers, and takes dictation Composes memos, transcribes notes, and researches and creates presentations Administers programs, projects, and/or processes specific to the operating unit served Communicates a
Posted 1 month ago
Assist the health plan in establishing a presence in the community through home visits and community outreach. Educate members on health care benefits through home visits and outreach Assist members with activities related to accessing care Document information and activities in applicable systems Deliver Connections Plus cell phones, teach and answer questions related to cell phone use and naviga
Posted 1 month ago
Dir, Clinical Quality Mgmt (1099262) Position Purpose The Director of Clinical Quality Management is responsible for the operations of Clinical Quality Management (CQM) within the Company. The Director of CQM is also responsible for ensuring conformance to the Company's quality system in accordance with customer and company requirements. Develops and maintains an integrated, well defined departmen
Posted 2 months ago
Military Family Life Counselor (0091X) Position Purpose The Counselor is a licensed mental health professional who exercises discretion and independent judgment to provide appropriate information, coaching, training, and education to Service Members and their families. The Counselor provides face to face direct, non medical, brief, solution focused counseling services to individuals, couples, fam
Posted 2 months ago
Referral Specialist I (1098421) Position Purpose Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone que
Posted 2 months ago
Handle inbound and outbound member and provider calls on a clinical phone queue. Ensure members receive behavioral health services appropriate to clinical need. Triage crisis calls to assist with stabilization and access to emergency evaluation. Coordinate services with other departments, such as medical case/care management. Perform utilization management functions, including authorization determ
Posted 2 months ago
Business Analyst III (1098438) Description Position Purpose Perform various analysisand interpretation to link business needs and objectives for assigned function. Position Responsibilities Provideadvance analytical and reporting support for business operations in all or someof the following areas claims, provider data, member data, clinical data,HEDIS, pharmacy, external reporting Developdashboar
Posted 2 months ago
Bilingual (English/Spanish) Medicare Territory Sales Represenative (Los Angeles / Huntington Beach) (1092950) Position Purpose The Medicare Territory Sales Representative is responsible for educating, selling, and enrolling Medicare beneficiaries into a Health Net Medicare Programs product. This position is also responsible for marketing activities using a variety of marketing support materials to
Posted 3 months ago
Referral Specialist I (1094988) Position Purpose Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone que
Posted 3 months ago
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