27 health care jobs found in Pasadena, CA

Therapist for Foothill Family Service. Master Deg Counseling Social Work Psychology. License from CA Board of Behavioral Services required. Travel to different schools within community needed. Salary $53,331.00 to $79,997.00. Worksite at 11429 Valley Blvd, El Monte, CA 91732. Rsm to HR, 2500 E. Foothill Blvd, Suite 300, Pasadena, CA 91107 recblid utyxtldcxugw4b4jmsot8vvp6qz6f3

Social Worker: Formulate life plans & rehab plans for seniors & disabled indivs, provide psychosocial spprt, counsel clients to help them recover from illness, & cndct social rsrch to advance knowl in social wrk. A master's deg in Gerontology, Psychology or Counseling is req'd. Salary: $ 58,614.00/yr. Send resume to Arcadia ADHC Inc. at 288 E. Huntington Dr, Monrovia, CA 91016. recblid 9d4n8370o1cu3aqh1v4kixf0aku52p

Job Description Job Description Responsible for assisting members with questions regarding authorizations and providers. Representatives will also be responsible for logging calls to summarize the issue, follow up and resolution. Duties and Responsibilities 1. Answer inbound calls from members and assists them with questions regarding authorizations, provider selection and other issues. 2. Learns IPA business rules and assists with basic authorization set up. 3. Actively performs transactions in response to member requests and displays professional telephone etiquette. 4. Work with specialists, PCPs and ancillary providers to assist with scheduling members for above services when necessary. 5. Consistently meets deadlines and service level requirements for hold time and call volume. 6. Demonstrates ability to use the computer to perform job functions. 7. Asks for assistance, when necessary, to handle more complex issues. 8. Displays flexibility to perform administrative...

Job Description Job Description The Health Plan Liaison is the main point of contact between Outpatient UM team members and Health Plan personnel. This role oversees referral requests that are delegated to the Health Plans (i.e. tertiary, DME, pharmacy, etc.), from the initial provider request until the final decision from the Health Plan is made. Reporting to the Outpatient UM Manager, the Health Plan Liaison adheres to MPM company policies and procedures.   Duties and Responsibilities · Communicates with OP UM nurses and coordinators to identify Health Plan delegated decisions · Completes Health Plan service request form and submits for decisions (via email and/or fax) · Assures that sent requests are complete with all necessary clinical and member information required for review · Assures that requests adhere to CMS and DMHC regulations for timeliness standards · Contacts provider offices for additional member information, as needed · Outreach to Health Plans for...

Job Description Job Description Summary: Responsible for overseeing the quality of both outpatient and inpatient coded clinical and administrative date. Responsible for synthesizing audit findings to provide actionable feedback to physicians and administrators on areas of improvement. Candidate is expected to be an active participant in continuous quality improvement processes and workgroups with a strong partnership with HCC co-worker specialists and other quality management staff. Educate providers and administrative staff on correct coding and charting as it applies to Medicare Advantage and Covered CA members. Will provide in-services in small and large group settings. May requires driving to Southern CA clinics and provider offices.   Duties and Responsibilities: 1. Reviews and audits medical records at provider offices/clinics to identify coding risk areas and ensure that training activities are addressing these areas. 2. Review records for completeness, accuracy...

Job Description Job Description Summary Responsible for engaging members to schedule appointments for preventive care and chronic care services. Representatives will also be responsible for logging calls and creating reports as needed to show scheduling progress. Duties and Responsibilities 1.       Use member gap reports to call members and encourage him/her to schedule preventive care and chronic care services to meet HEDIS/STARs requirements 2.       Work with specialists, PCPs and ancillary providers to assist with scheduling members for above services 3.       Contact members to encourage completion of annual member satisfaction surveys 4.       Log outbound and inbound calls into sPHERICAL member outreach module 5.       Create reports on a weekly and monthly schedule to show scheduling progress 6.       Collaborate on innovative programs to more fully engage members and improve participation in these areas 7.       Assist HEDIS/STARs quality coordinators on...

Job Description Job Description   MedPOINT Management Title: Inpatient Nurse - Delegated Plans ===================================================================================== MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmangement.com   Duties and Responsibilities for Delegated Plans: 1. Facilitates patient’s transfer to capped hospital when admitted to an out of network or out of capped facility and needs continued hospitalization. The nurse follows the Out of Network Transfer Protocol below: a. The nurse calls the assigned hospitalist where the patient is to be transferred to and lets him/her know that the current attending physician will be calling to discuss continuation of care or vice-versa. b. The nurse calls the capitated hospital to check if bed is...

Job Description Job Description MedPOINT Management is committed to conducting its business and operations following the highest legal and ethical standards. Our Code of Conduct sets forth our expectations of management, employees, and contractors to act under applicable laws and Company policy. MedPOINT’s Compliance Department ensures our culture maintains ethical standards, strives to significantly reduce the risk of fraud, abuse, and waste in the healthcare industry, and enhances the quality of services and care to patients. The Federal Sentencing Guidelines for Compliance Programs guide MedPOINT’s Compliance Program.   Duties and Responsibilities 1.       Prepares and submits audit universe reports to external auditors from health plans 2.       Review and validate audit documents to external auditors from health plans 3.       Assists with internal quality reviews of department processes 4.       Supports Health Plan Oversight Audits/Ad Hoc Requests 5....

Job Description Job Description Summary The Outpatient UM Coordinator provides effective communication between MSO, IPA providers, and members to coordinate member care. Communication to include accessibility to care, validating contract entities, and ensuring timeliness standards are met. The Outpatient UM Coordinator reports directly to the Outpatient Lead Coordinator under the guidance of the manager. Duties and Responsibilities · Process authorization requests per state and federal timeliness regulations · Validate data entry process for errors · Verify member benefits and eligibility upon receipt of treatment authorization request · Utilizes authorization matrix, ancillary rosters, DOFR and/or delegation agreements to drive decision-making · Coordinates with referral Clinician and/or Medical Director for timely processing · Communicate with Medical Directors to facilitate Medical Reviews for non-clinical medical review referrals · Outreach to members on...

Job Description Job Description Seeking a highly motivated candidate to outreach to Medi-Cal members of HCLA in need of health care improvement interventions. Candidate must be able to motivate and guide patients to visit their Primary Care Physician (PCP) office.  A goal of improving compliance with completion of these quality screening tests and exams is a crucial component of the position. Duties and Responsibilities: Using several HCLA available HCLA databases, contact potential patients and educate members on the importance of scheduling appointments that will vastly improve their health status. There are approximately 15 health screening measures members may be eligible to complete within the year. Assist members in making their appointments. Address any barriers to accessing the care to ensuring members receive services in a timely manner. Improve patient health outcomes through member engagement. Complete a specified volume of outreach calls daily for assigned PCP...

Job Description Job Description Provides overall coordination in the delivery of medical services and discharge planning for a specified patient population.  Performs concurrent review of patient medical records for purposes of utilization review, compliance with requirements of external review agencies including governmental and non-governmental payers and quality assurance agencies.  Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physicians, funding representatives and community agencies.  Ensures continuity in the handoff of patient clinical information from the hospital to other involved healthcare entities.    Duties and Responsibilities ·         Responsible for all Duties & Responsibilities in the Inpatient Nurse Case Manager job description. ·         Provides coverage as needed and follows concurrent policies, procedures, and workflow. ·         Attends the daily inpatient meeting to go over daily bed day...

Job Description Job Description Responsible for collaborating with CVO, credentialing staff and provider services to coordinate, monitor and maintain the credentialing and re-credentialing process. Responsible for the accuracy and integrity of the credentialing database system and related systems.  Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Prepares files for monthly credentialing committee and health plan audits. Works under the supervision of the VP, Quality Management and Manager, Compliance. Duties and Responsibilities 1.       Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. 2.       Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up. 3....

Health Records Director: Develop, maintain record mgmt systems to store, process patient & lab. data. Plan, administer records maintenance program in adult day health care center, develop policies/strategies for data accuracy, security. Maintain records of advances in data processing technology, govt regs, health insurance changes, financing options. Prepare reports for mgmt. re status/implementation of records collection, maintenance programs. Bachelor in Health Care Management, or Health Sciences, or Nursing & 2 yrs. exp. 40 hrs/wk. Fax resume to (818) 705-5566. Golden Age Adult Day Health Care Center, Inc., Tarzana, CA. recblid 3xo84i3gqwwg37ttpahx9jjqwix7qm

Quest Diagnostics Inc. seeks Clinical Laboratory Scientists (multiple) in San Juan Capistrano, CA to test, analyze, & report. Req's: Bach. degree (or for. equiv.) in Med Tech, Chem, Bio, or rel. field; CA State CLS license (or license eligible). All shifts. Salary: $37.41- $69.99/hr. Resume to: Tina.X.Luree@questdiagnostics.com using job code "SJC". recblid sus0g880v876ymj99qevvd64sk7csb

Job Description Job Description Summary Under the direction of the Sr. Manager, Provider Network Operations (PNO), the PNO Business Analyst partners with all organization levels to lead projects, drive results, and resolve problems. Responsibilities include documenting PNO team members' business requirements, processes, and workflows, and creating written and visual depictions of these. Additionally, the analyst will analyze data, identify trends, and produce provider network and process improvement reports. Duties and Responsibilities: Determine operational objectives by studying business functions, gathering information, and evaluating output requirements. Conduct insightful ad hoc analyses to investigate operational issues. Construct workflow charts and diagrams; write specifications. Improve processes by studying current practices and designing modifications. Define project requirements by identifying milestones, phases, and elements. Monitor project progress by...

Job Description Job Description Under the general direction of the Provider Network Operations (PNO) – Provider Network Management Supervisor, the In-House IPA Representative serves as the liaison between the IPA clients, IPA client’s contracted providers and health plan(s). They will be responsible for the executing the provider onboarding, update, and termination processes for the MedPOINT Management (MPM) managed client IPAs. The In-House IPA Representative ensures the timely and accurate update of provider information system/database, resolution of providers’ issues, State/health plan reporting, and improving all provider business experiences with their assigned IPA. They will interface with PNO, Credentialing, Utilization Management (UM) and other MedPOINT Management (MPM) departments to facilitate numerous processes, including but not limited to Credentialing assistance, UM coordination, contracting support, health plan communications, and Provider communications. Duties...

Job Description Job Description The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.   Duties and Responsibilities · Accurately review all incoming Provider claims to verify necessary information is available. · Meets production standards of 100-150 claims as established by claims management · Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims. · Coordinate resolution of claims issues with other Departments. · Assist Providers, Members and other Departments in claims research. · Provide backup for other examiners within the Department. · Assist in training of new claims personnel. · Promote...

Job Description Job Description The Inpatient After Hours Coordinator Level II is responsible for assisting the After Hour Nurse Case Managers with the coordination of patient care within established timeframes and utilizing established guidelines. They will report directly to the After Hours Lead. Duties and Responsibilities ·         Generates authorization numbers (eg. inpatient, transportation, ARU, SNF/SAU, etc) and send copy to vendor hospitals per Afterhours Nurse directive. ·         Assists with repatriation of patients from out of network facilities to their contracted/capitated facility. ·         Ensure contracted Hospitalists/Specialists are utilized for admissions, transfers, and repatriations. ·         Verifies patient’s eligibility using EZ Cap, Health Plan website, Medical website, and Passport. ·         Supports Afterhours Nurse Case Managers by calling hospitalist/specialist, sending transfer packet, following up on bed status, arranging...

Job Description Job Description Summary Oversees the higher level of care cases and the process and the management of our inpatient transplant cases. Will be responsible for answering any questions the inpatient nurses might have during their shift with the direction of the Lead La Care Shared Risk Nurse, and Medical Directors. Provides overall coordination in the delivery of medical services and discharge planning for a specified patient population. Duties and Responsibilities · Maintains updated list of HLOC facilities for Health plans / capped hospitals. · Maintains workflow for HLOC, Transplant, COC workflow process for the team to follow · Provides cheat sheet for go to specialists for the team to easily access. · Maintains list of hospitals that do special procedures, not limited to, EUS, open MRI, TAVR, and etc. · Oversees HLOC Cases and Inpatient Transplant cases · Ensures that communication regarding HLOC cases and transplant cases is clear and easy to...

Job Description Job Description Summary: A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Research, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff. The Claims auditor also performs special projects and helps department manager and director as needed. They review and audit the Examiners’ adjudicated claims for accuracy and providing feedback.   Duties and Responsibilities: · Audit daily processed claims through random selection as outlined by organizational Policies and Procedures. Utilize appropriate system-generated reports applicable to specialty claims. · Conduct Claims Examiner training as required. Document training materials and attendees. · Conduct in-depth research of...