Jobbörse

Essential Duties and Responsibilities include the following:

• Works collaboratively with SVP of Regional Operations, medical director leadership, managers and staff working in concurrent review/Vital Care management/Prior Authorization Departments, Contract Directors, Network Management leadership, and Finance/Decision Support to ensure financial performance of an assigned campus.
• Monitors and analyzes UM protocols and identifies trends and makes recommendations and develops programs and interventions to improve management.
• Develops and coordinates strategies, in collaboration with SVP of Regional Operations and Medical Director leadership, for ensuring the delivery of care in the most cost effective setting. (i.e. hospitals), facilitating the right care at the right time and right setting.
• Supports Network Operations and medical management operations, works with staff including contracting, network management, concurrent review, prior auth and vital care staff in order to achieve company goals and metrics.
• Interprets and analyses campus utilization and budget reports with daily tracking and monitoring whenever possible.
• Develops / implements performance improvement plans for utilization and cost outliers identified.
• Assures most efficient contracted providers are utilized and collaborates with the Contracting Departments to obtain new contracts for specialty and ancillary services.
• Provides guidance and support to Directors, managers and staff working in Utilization Management/Contracting/Network Management as it relates to improving performance of the campus.
• Monitors and analyzes UM protocols and identifies trends and makes recommendations and develops programs and interventions to improve outpatient budget as well as processes.
• Identifies opportunities for the development and implementation of new approaches that improve efficiencies and production while maintaining quality.
• Works collaboratively with the Network Management and Medical Management teams to assure appropriate processes are in place to maintain compliance with regulatory bodies.
• Works with Decision Support and/or IT to provide ad hoc reports and other projects as assigned or required
• Effectively analyzes and when needed negotiates contract rate and language proposals and drafts contracts and other documents to support agreed upon terms.
• Works closely with Network Management leadership and medical director to conduct meetings with targeted providers for the purpose of reviewing and improving operational and financial results.
• Participation on cross-functional projects requiring collaboration with key internal departments.
• Coordinates or performs campus project/activities as delegated.

The pay range for this position at commencement of employment is expected to be up to $130,000 year; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus 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.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and/or Experience:

Required

• College BA, BS, Masters preferred.
• One year or more experience in managed care environment
• Proficient with Microsoft applications

Preferred

• Masters Degree, MS
• Proficient in Company database software such as CART
• Experience in coordinating inpatient and outpatient case management
• Experience managing disease management programs

Policies:

• Communicate verbally and in writing through appropriate channels.
• Maintain confidentiality and follow HIPAA policies.
• Follow dress code.
• Participate in staff meetings.
• Notify supervisor in writing of time of requests.
• Be courteous and promote professionalism.
• Be flexible and adaptable.
• Promote organizational goals.
• Know and follow safety standards.