Job Summary:

Promote the quality and cost effectiveness of medical care through dissemination of health plan and provider information and the implementation of processes to streamline the referral process. Monitor the production for quality and appropriateness in the application of criteria and use of contracted providers. Maintain a professional, positive and caring attitude at all times.

The pay range for this position at commencement of employment is expected to be between $49,920.00 and $68,744.00/year, non-exempt; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

EDUCATION, TRAINING, EXPERIENCE:

• High school graduate or equivalent.
• Current California LVN or RN license required.
• Three to five years of managed care experience in a medical group or IPA, strongly preferred.
• Experience with health plan audits/compliance and NCQA requirements, strongly preferred.
• Knowledge of managed care industry, required.
• Knowledge of Healthcare and Managed Care, preferred.
• Knowledge of computers, faxes, printers and all other equipment.
• Proficient in MS Office Suite (i.e., Word, Excel, Outlook, and Power Point).
• Excellent written and verbal communication skills.
• Excellent organizational, interpersonal and analytical skills, required.
• Ability to handle and prioritize tasks in order to meet all given deadlines and productivity goals.
• Ability to responsibly handle matters of a confidential nature.
• Ability to work in a multi-task, high-productive environment.
• Background in managed care, knowledge of Medicare and Medi-Cal, along with health plan and CMS guidelines.
• Ability to review and make determination of requests for clinical services.
• Bilingual preferred but not required.