Job Description. Provide efficient and accurate information to prior authorization requests. Ensure that correct benefits, co-pays and financial responsibility are provided to Prior Auth requestors. Education and/or Experience. 2-4 years of experience with HMO referrals and prior authorizations. Knowledge of Healthcare and Managed Care preferred. Typing 40 words per minutes with accuracy. Knowledge of computers, faxes, printers and all other equi...
Job Description. Position Summary. The After Hours Coordinator supports the process that manages the Afterhours Call Department. The goal for this position is to effectively support the Afterhours Call Services management process by assuring the right information is provided timely to the team. This includes ensuring that all necessary clerical functions are completed accurately and timely. Assist in facilitating referrals, transfers and authoriz...
The Renal Care Coordinator, Outpatient is a non-licensed team member responsible for coordinating non-clinical tasks to support the delivery of case for high risk members with Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD). Responsibilities include, but are not limited to, assisting in care coordination, supporting member education activities, maintenance of member records and track progress, assume liaison role in the facilitati...
Job Description. Position Summary. The Employee Services Coordinator is responsible for providing support with the heavy administrative workload of the department. This position is also be responsible for assisting in all HPN audits, approximately 4-5 a month, that focus on Compliance and ADP uploads and with the collection of side attestations. This role manages submitting and tracking Compliance Training for all new hires and temps, which inclu...
Job Description. Position Summary. The After Hours Coordinator supports the process that manages the Afterhours Call Department. The goal for this position is to effectively support the Afterhours Call Services management process by assuring the right information is provided timely to the team. This includes ensuring that all necessary clerical functions are completed accurately and timely. Assist in facilitating referrals, transfers and authoriz...
The Director of HCC plans, organizes, directs and controls the activities and staff required to provide chart review, data validation, medical record organizing, scanning and ensure timely provider feedback. This position is responsible for organizing, training and directing the activity of the HCC department This position directly oversees HCC Coders and Auditors as well as oversight of chart review and special projects. Essential Duties and Res...
Job Description. The Clinical Project Manager is responsible is responsible for monitoring the care efficiency of the inpatient team through the movement of patients through the inpatient care experience. They are also responsible for knowing the contractual relationships and clinical capabilities of the inpatient facilities. Another responsibility is to monitor the transition process from community, institutional (skilled nursing, assisted livin...
Job Description. Position Summary. This position is directly responsible for researching and maintaining coordination of benefits of all contracted and non-contracted health plan entities as reported by any health plan, provider, Medicare, TPL, Workers Comp or internal departments. They are to ensure that all EZ-Cap system eligibility data is current and accurate. Researches and maintains systems and changes to existing eligibility in a timely ma...
Job Description. The Director of Social Services is responsible for overseeing the Social Services Department. They will provide oversight and guidance to the campus social workers who are providing assistance to members and their families in the form of counseling and resource referral. Provides training, standardization of processes, compliance oversight, outcomes assistance, performance evaluation and be a clinical resource to the social servi...
Ideal candidates will have. At least 2 years of acute care or managed care experience. Inpatient , Outpatient case management experience. An active CA Nursing License in good standing. Regal Medical Group is holding an On-site Hiring Event for Nurses -LVN's and RN's. Come meet us On-site and meet with hiring managers and the recruitment team. Date. Tuesday, February 18th, 2025. Time. 11 : 00am to 3 : 00pm. Location. 8510 Balboa Blvd, Suite 110. N...
