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Referral Specialist I (1105957) 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 days ago
Supervisor, Customer Service (1114967) 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 5 days ago
Business Analyst IV (1114819) Position Purpose Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements. Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Lead the identification and analysis of user requir
Posted 20 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 24 days ago
Behavioral Health Clinical Care Mgr (1113339) 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, such as medical case/care management. Perform u
Posted 24 days ago
Health Net
- Huntington Beach, CA
Program Coordinator I (1108188) 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 25 days 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
TRICARE Client Liaison (1108415) Position Purpose Maintains tables and MOU components for MTFs/eMSM. Initiates changes to these tables and related documents and ensures updates are made timely in HNFS support systems. Ensures contract is properly administered; explains administrative procedures relating to functional area to MTF command. Closely monitors customer service and support delivered by t
Posted 2 months ago
Care Manager II (CA) (1108319) Position Purpose 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, treat
Posted 2 months 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 3 months ago
Health Net
- Huntington Beach, CA
Behavioral Case Manager (CEN1053721) Position Purpose Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaboration wit
Posted 16 months ago
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