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Bilingual (English/Spanish) Enrollment & Retention Representative (State Health Programs) (1081297) 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. Additional respon
Posted 3 days ago
Provider Relations Representative II (1078376) Position Purpose This position interacts with health care providers and their office staff via phone and email. This individual provides information to TRICARE providers with regards to TRICARE Program and specifically Provider Network Operations and serves as the key provider education mechanism. The Provider Relations Representative II coordinates a
Posted 11 days ago
Membership Retention Spec (1068251) Position Purpose The Membership Retention Specialist is responsible for activities related to strengthening customer relationships through member education relative to benefits and Plan usage and for local "high touch" outreach to improve membership retention of current and new Health Net Medicare Advantage, Part D members, CalMediConnect Members, etc. Acts as l
Posted 18 days ago
Supervisor, Customer Service (1078642) Position Purpose Supervise assigned customer service function at the health plan to meet overall business goals and objectives Ensure the team meets its goals and objectives through effective hiring, performance management, coaching and career development Act as the Complaints Coordinator; ensuring all complaints are resolved and responded to appropriate part
Posted 19 days ago
Prior Authorization Nurse I (1080761) Position Purpose Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward request
Posted 19 days ago
Dental Operations Manager CA Woodland Hills or Glendale (1080356) Position Purpose The Dental Operations Manager is responsible for managing, directing and supporting the dental operations for our Medi Cal, Healthy Families and Medicare members. The director is also responsible for ensuring compliance with our Department of Health Services (DHS) and Healthy Families MRMIB contracts. Monitors Healt
Posted 19 days ago
Support the Biostatistics component of the Health Econ and Outcome Research (HEOR) team by assisting investigators in managing and analyzing clinical data as well as interpreting and reporting results. Write detailed statistical analysis plans including specifications for analysis files, consistency checks, tables, and figures. Responsible for data management, operational reporting and predictive
Posted 24 days ago
Behavioral Health Clinical Care Manager LCSW or LMFT Huntington Beach, CA #1076848 (1076848) Position Purpose 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,
Posted 26 days ago
Health Net
- Huntington Beach, CA
Analyze health management programs including data collection, validation and outcome measurement. May include o Financial, pharmacy, claims, provider, and member data o IRS, CMS, HHSC, HEDIS reporting o Internal data cleansing and data reconciliation analysis o Trend analysis in various functional areas of health care management. Create and generate reports through MS Excel, MS Access, and SQL usi
Posted 30 days ago
Health Net
- Huntington Beach, CA
The Territory Manager 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 generate sales leads, sales and marketing activity reporting, and customer outreach and support. Performs all sales and marketing related activities
Posted 1 month ago
Pharmacist Specialty Pharmacy Per Diem CA Commerce (1073784) Position Purpose Coordinate and assist in managing and participating in pharmacy services, including compounding and dispensing of medications, quality assurance and clinical monitoring activities. Participate in decisions regarding the pharmaceutical services within assigned scope including o Assessing the patient's general pharmaceutic
Posted 2 months ago
Case/Care Manager I (1060883) Position Purpose Provides case/care management services to a specific clientele. Screens cases for possible case management services according to predetermined criteria. Systematically identifies and addresses fragmentation of care, and fill gaps in care using proactive initiatives. Authorizes inpatient and/or outpatient treatment according to company's stated criteri
Posted 2 months ago
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. 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 ski
Posted 2 months ago
Long Term Care Specialist (CENHNT35082 01) Position Purpose Responsible for assessing and triaging needs based upon assessments completed for long term and support services, and assisting Members by facilitating their needs, and by providing appropriate referrals. Demonstrates regular, reliable and predictable attendance. Ensure LTSS Members admitted to nursing facilities or rehabilitative institu
Posted 2 months ago
Community Relations Representative I (Huntington Beach or San Diego) (CEN1056356) Position Purpose Provide sales coverage and develop best possible market penetration for all lines of business to present to prospective members in assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education, assistance and coordinating com
Posted 4 months ago
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