Caloptima Careers Jobs in Usa
4 positions found
C
Behavioral Health Utilization Management Medical Case Manager
Salary not disclosed
Behavioral Health Utilization Management Medical Case Manager
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Behavioral Health Utilization Management Medical Case Manager and help shape the future of healthcare where you'll be an integral part of our BHI ‐ BH Utilization Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for authorization and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. You will be responsible for prior authorizations, concurrent review and related processes. You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health professionals, clinical facilities and ancillary providers. You will directly interact with providers and facilities and serve as a resource for their needs. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 85% ‐ Utilization Management Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
- Responsible for mailing rendered decision notifications to the provider and member, as applicable.
- Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow‐up in the utilization management system.
- Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
- Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.
- Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature.
- Refers cases of possible over/under utilization to the Medical Director for proper reporting.
- Completes care coordination activities as related to Transition Care Management (TCM) activities.
- Reviews International Classification of Diseases (ICD‐10), Current Procedural Terminology (CPT‐4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business.
- 10% ‐ Administrative Support
- Assists manager with identifying areas of staff training needs and maintains current data resources.
- Complies with data tracking protocols.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required education PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You'll Stand Out More If You Possess the Following:
- Utilization management reviewer experience.
- Managed care experience.
- Behavioral health clinical experience.
What the Regulatory Agencies Need You to Possess?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 313 ‐ $90,820 ‐ $145,312 ($43.66 ‐ $69.8615).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
- A
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Behavioral Health Utilization Management Medical Case Manager and help shape the future of healthcare where you'll be an integral part of our BHI ‐ BH Utilization Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for authorization and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. You will be responsible for prior authorizations, concurrent review and related processes. You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health professionals, clinical facilities and ancillary providers. You will directly interact with providers and facilities and serve as a resource for their needs. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 85% ‐ Utilization Management Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
- Responsible for mailing rendered decision notifications to the provider and member, as applicable.
- Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow‐up in the utilization management system.
- Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
- Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.
- Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature.
- Refers cases of possible over/under utilization to the Medical Director for proper reporting.
- Completes care coordination activities as related to Transition Care Management (TCM) activities.
- Reviews International Classification of Diseases (ICD‐10), Current Procedural Terminology (CPT‐4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business.
- 10% ‐ Administrative Support
- Assists manager with identifying areas of staff training needs and maintains current data resources.
- Complies with data tracking protocols.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required education PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You'll Stand Out More If You Possess the Following:
- Utilization management reviewer experience.
- Managed care experience.
- Behavioral health clinical experience.
What the Regulatory Agencies Need You to Possess?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 313 ‐ $90,820 ‐ $145,312 ($43.66 ‐ $69.8615).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
- A
Not Specified
C
Social Worker (PACE)
✦ New 🏢 CalOptima
Salary not disclosed
Social Worker (PACE)
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Social Worker (PACE) and help shape the future of healthcare where you'll be an integral part of our PACEC ‐ Social Work team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Social Worker for the Program for All‐Inclusive Care for the Elderly (PACE) will be responsible for direct social work care management services, such as participant screening, case management, counseling and referrals of participants to PACE. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 70% ‐ Care Management
- Participates in a mission driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Participates in the Interdisciplinary Team's (IDT) initial, six (6) month and annual assessments, as well as care planning of the participant's case in accordance with industry and departmental standards.
- Documents participant changes appropriately in the medical record in accordance with industry and departmental standards.
- Communicates effectively and openly with other IDT members on participant status and needs.
- Assesses patients for high‐risk situations such as suicidal/homicidal ideation and abuse. Reports appropriately in accordance with legal and ethical standards of practice and engages in safety planning with participants and/or family.
- Develops and leads group counseling and participant support group activities.
- Refers participants and families to appropriate community agencies or facilities, serves as a liaison with such organizations and as an advocate for participants.
- Assists in the completion of advance directives, mortuary arrangements, funeral planning and/or facility placement.
- Aids patients/representatives in ascertaining third‐party and financial resources and planning for financial coverage for services as necessary.
- Addresses any psychosocial needs that may require social work support and intervention (e.g., anxiety, depression and other behaviors), both at the center and at home.
- Works with PACE participants and the IDT to develop an appropriate discharge plan for disenrolling from PACE services.
- May be required to perform home visits to private homes of CalOptima Health's PACE participants; frequent travel in Orange County.
- Support PACE participants with care coordination needs, such as transportation, family communication, scheduling visits to the center, supporting with warm handoff process to our community partners.
- Represents and supports the participant's care management needs by being an advocate for their care, supporting clinical needs such as supportive counseling, developing care plans to manage all psychosocial needs (i.e., establishing support systems, coping mechanisms, assessing depression, anxiety, cognition) and developing interventions.
- 25% ‐ Support Services
- Assists the team in carrying out department responsibilities and collaborates with others to support short and long‐term goals/priorities for the department.
- Consults with and advises staff members regarding the relationship of social, emotional and cultural factors to health and medical care and the availability of social services in the community.
- Attends and participates in in‐services, staff meetings and case conferences.
- Helps support the new enrollee process of enrollment into the PACE program (e.g., communicates to IDT and ensures all service gaps are covered prior to enrollment).
- Participates in program improvement for the Social Work department.
- Works with the Quality Improvement (QI) department to support grievances, appeals and advocacy consistent with participant's rights.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Master's degree in social work from an accredited college or university PLUS 2 years of experience in a health‐related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- 1 year of experience working with the elderly population with relevant experience within the last 3 years required.
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
- CPR and First‐Aid Certification required or must be obtained within six (6) months of the date of hire.
- Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more.
You'll Stand Out More If You Possess the Following:
- 1 year of case management experience with the elderly population.
What the Regulatory Agencies Need You to Possess?
- N/A
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Social Worker (PACE) and help shape the future of healthcare where you'll be an integral part of our PACEC ‐ Social Work team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Social Worker for the Program for All‐Inclusive Care for the Elderly (PACE) will be responsible for direct social work care management services, such as participant screening, case management, counseling and referrals of participants to PACE. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 70% ‐ Care Management
- Participates in a mission driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Participates in the Interdisciplinary Team's (IDT) initial, six (6) month and annual assessments, as well as care planning of the participant's case in accordance with industry and departmental standards.
- Documents participant changes appropriately in the medical record in accordance with industry and departmental standards.
- Communicates effectively and openly with other IDT members on participant status and needs.
- Assesses patients for high‐risk situations such as suicidal/homicidal ideation and abuse. Reports appropriately in accordance with legal and ethical standards of practice and engages in safety planning with participants and/or family.
- Develops and leads group counseling and participant support group activities.
- Refers participants and families to appropriate community agencies or facilities, serves as a liaison with such organizations and as an advocate for participants.
- Assists in the completion of advance directives, mortuary arrangements, funeral planning and/or facility placement.
- Aids patients/representatives in ascertaining third‐party and financial resources and planning for financial coverage for services as necessary.
- Addresses any psychosocial needs that may require social work support and intervention (e.g., anxiety, depression and other behaviors), both at the center and at home.
- Works with PACE participants and the IDT to develop an appropriate discharge plan for disenrolling from PACE services.
- May be required to perform home visits to private homes of CalOptima Health's PACE participants; frequent travel in Orange County.
- Support PACE participants with care coordination needs, such as transportation, family communication, scheduling visits to the center, supporting with warm handoff process to our community partners.
- Represents and supports the participant's care management needs by being an advocate for their care, supporting clinical needs such as supportive counseling, developing care plans to manage all psychosocial needs (i.e., establishing support systems, coping mechanisms, assessing depression, anxiety, cognition) and developing interventions.
- 25% ‐ Support Services
- Assists the team in carrying out department responsibilities and collaborates with others to support short and long‐term goals/priorities for the department.
- Consults with and advises staff members regarding the relationship of social, emotional and cultural factors to health and medical care and the availability of social services in the community.
- Attends and participates in in‐services, staff meetings and case conferences.
- Helps support the new enrollee process of enrollment into the PACE program (e.g., communicates to IDT and ensures all service gaps are covered prior to enrollment).
- Participates in program improvement for the Social Work department.
- Works with the Quality Improvement (QI) department to support grievances, appeals and advocacy consistent with participant's rights.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Master's degree in social work from an accredited college or university PLUS 2 years of experience in a health‐related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- 1 year of experience working with the elderly population with relevant experience within the last 3 years required.
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
- CPR and First‐Aid Certification required or must be obtained within six (6) months of the date of hire.
- Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more.
You'll Stand Out More If You Possess the Following:
- 1 year of case management experience with the elderly population.
What the Regulatory Agencies Need You to Possess?
- N/A
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
Not Specified
C
Home Care LVN (PACE)
✦ New 🏢 CalOptima
Salary not disclosed
Home Care LVN (PACE)
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Home Care LVN (PACE) and help shape the future of healthcare where you'll be an integral part of our PACE‐ Clinic team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
Under the direct supervision of the Home Care Supervisor, the LVN for the Program for All‐Inclusive Care for the Elderly (PACE) for home care will be responsible for the development and implementation of home care services for program participants, including the coordination of durable medical equipment (DME) and community‐based care. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 95% ‐ Home Care Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Evaluates the home environment and identifies the different areas where the participant needs home care staff to assist.
- Works with the Interdisciplinary Team (IDT) to develop specific plans of care to address the participant's home care needs.
- Receives reports from home care staff and communicates participant changes to the IDT in a timely manner.
- Schedules and coordinates home care staff for in‐home care delivery and the implementation of all personal care services to ensure that quality services are provided to meet participant needs.
- Coordinates all DME provisions in the home setting and collaborates with the IDT on DME authorization requests.
- Completes initial and annual evaluations of the home environment for coordination of care and completion of participants care plan.
- Documents participant changes appropriately in the medical records and communicates participant changes to the IDT.
- Maintains current knowledge of standards and best practices for home care.
- Takes the lead by coordinating and integrating services within the department, with other departments and with the IDT's primary functions.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- High school diploma or equivalent PLUS 3 years of nursing experience working with the frail or elderly population within the last 3 years in a health care or managed care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- CPR and First‐Aid Certification required or must be obtained within six (6) months of the date of hire.
- Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 40% of the time or more.
You'll Stand Out More If You Possess the Following:
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
What the Regulatory Agencies Need You to Possess?
- Current LVN license in good standing to practice in the state of California is required, which is typically obtained through graduation from an accredited vocational nursing school.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 311 ‐ $77,863 ‐ $124,581 ($37.43 ‐ $59.8947).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Office (**If the position is Telework, it is eligible in California only**)
- A comprehensive benefits package
- CalPERS pension program and additional retirement packages.
- Additional benefits and perks including:
- A generous PTO program
- A quality work life balance
- Various wellness program
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Home Care LVN (PACE) and help shape the future of healthcare where you'll be an integral part of our PACE‐ Clinic team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
Under the direct supervision of the Home Care Supervisor, the LVN for the Program for All‐Inclusive Care for the Elderly (PACE) for home care will be responsible for the development and implementation of home care services for program participants, including the coordination of durable medical equipment (DME) and community‐based care. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 95% ‐ Home Care Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Evaluates the home environment and identifies the different areas where the participant needs home care staff to assist.
- Works with the Interdisciplinary Team (IDT) to develop specific plans of care to address the participant's home care needs.
- Receives reports from home care staff and communicates participant changes to the IDT in a timely manner.
- Schedules and coordinates home care staff for in‐home care delivery and the implementation of all personal care services to ensure that quality services are provided to meet participant needs.
- Coordinates all DME provisions in the home setting and collaborates with the IDT on DME authorization requests.
- Completes initial and annual evaluations of the home environment for coordination of care and completion of participants care plan.
- Documents participant changes appropriately in the medical records and communicates participant changes to the IDT.
- Maintains current knowledge of standards and best practices for home care.
- Takes the lead by coordinating and integrating services within the department, with other departments and with the IDT's primary functions.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- High school diploma or equivalent PLUS 3 years of nursing experience working with the frail or elderly population within the last 3 years in a health care or managed care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- CPR and First‐Aid Certification required or must be obtained within six (6) months of the date of hire.
- Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 40% of the time or more.
You'll Stand Out More If You Possess the Following:
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
What the Regulatory Agencies Need You to Possess?
- Current LVN license in good standing to practice in the state of California is required, which is typically obtained through graduation from an accredited vocational nursing school.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 311 ‐ $77,863 ‐ $124,581 ($37.43 ‐ $59.8947).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Office (**If the position is Telework, it is eligible in California only**)
- A comprehensive benefits package
- CalPERS pension program and additional retirement packages.
- Additional benefits and perks including:
- A generous PTO program
- A quality work life balance
- Various wellness program
Not Specified
C
Registration Representative
Salary not disclosed
Job Title: Registration Representative Location: Laguna Hills, CA 92653 Duration: 3 months+ (Possible Extension) Pay Range: $22 to $25 per hour.
on W2 Note: • Schedule is Saturday 6:30 AM – 5 PM Sunday 6:30 AM – 5 PM Monday 6:30 AM – 5 PM Tuesday – 9 AM
- 7:30 PM • Highly preferred to have Urgent care/Doctors’ office/Dental office experience Must have solid health insurance background.
Job Summary: · This position requires the full understanding and active participation in fulfilling the mission of.
· It is expected that the employee will demonstrate behavior consistent with our core values: Integrity, Accountability, Best Practices, Compassion and Synergy.
· The employee shall support ’s strategic plan and participate in and advocate performance improvement/patient safety activities.
· The Registration Representative is under the direction of the Supervisor/ Manager and is responsible for completing all registrations of patients presenting for procedures, admissions, outpatient and ER visits.
· The Representative must obtain and verify demographic and insurance information so that the patient can be accurately identified and billed for their services.
· The registration representative is responsible for collecting and posting the patient’s financial responsibility in Epic and immediately dropping the payment in the safe or locked cash drawer.
· Excellent customer service must be maintained with all patients, visitors, clinicians, and co-workers.
Skills: · Ability to communicate effectively in written and verbal form · Adheres to department policy of using two patient identifiers.
· Avoids HIPAA violations by choosing correct MRN and interviews, registers, and pre-registers patients timely and accurately in Epic.
· Ensures all registration forms are complete, signed, and scanned.
Enter notes in Epic as required.
· Ability to provide excellent customer service using Simply Better and AIDET principles.
· Collects and posts payments timely and accurately.
Immediately drops payment in safe or cash drawer.
· Ability to follow company policies, supports department performance improvement activities.
(Staff meetings, employee engagement survey, education, and training activities) · Maintains registration accuracy rate of 95% or better.
· Monitors and manages work queues.
· Ability to be at work and be on time.
Adheres to MHS time and attendance policy.
· Ability to follow company policies, procedures, and directives.
Supports department performance improvement activities.
(Meetings, employee engagement survey, education, and training activities) · Ability to interact in a positive and constructive manner.
· Ability to prioritize and multitask.
Essential Job Outcomes: · Adheres to department policy of using two patient identifiers ensuring correct information appears on all documents, armbands, and labels.
Adheres to a verbal verification of armband placement.
· Avoids HIPAA violations by accurately entering information into the Epic system to avoid passing on defects; such as incorrect patient name, PCP, guarantor and insurance information.
· Interviews, pre-registers and registers patients timely and accurately.
Appropriate level of expertise in Epic, OnBase, RTE, insurance websites to ensure accurate and efficient registrations.
· Ensures that all registration forms are complete, signed, scanned and indexed in Epic timely.
Enters notes in referral or auth/cert and uses billing indicator as needed.
· Delivers excellent customer service using “Simply Better” and AIDET principles with patients, staff, and visitors.
Maintains effective working relationships with co-workers and others.
Utilizing Simply Better recognition cards or any other communication regarding customer service.
· Collects and posts patient financial responsibility; including deposits, copays, deductibles, estimates, and/or coinsurance timely and accurately.
Drops payment in the safe or cash drawer timely.
Based on a monthly department cash collection goal.
· Participates in and supports department specific performance improvement education, training, staff meetings, and projects.
(Employee Engagement survey, service excellence, etc.) Promotes and participates in the employee engagement action plan).
Assists with improving the score.
· Maintains an accuracy of 95% or better by selecting the correct insurance plan and IPA code.
Monitors and manages assigned work queues to maximize productivity by meeting department standards.
Appropriate level of expertise in Epic, Onbase, RTE and insurance websites to ensure accurate and efficient registrations.
· Monitors assigned WQ’s to maximize productivity by meeting department weekly goals.
· Adheres to MHS time and attendance policy #357.
Clocks “in and out” of MTM accurately with minimal clocking errors for each scheduled shift.
Signs off by the end of the pay period.
· Other duties as assigned.
Experience: • 1-2 years of experience in hospital admitting, physician office, or equivalent healthcare • Must communicate effectively and clearly both verbally and in writing • Strong customer service skills • General knowledge of insurance payors: PPO, HMO, POS, EPO, Medicare, Medi-Cal, & CalOptima • Bi-lingual (English/Spanish, or English/Vietnamese) preferred • Positive work ethic • General computer skills required including electronic medical record and Microsoft Office • Knowledge of medical terminology
on W2 Note: • Schedule is Saturday 6:30 AM – 5 PM Sunday 6:30 AM – 5 PM Monday 6:30 AM – 5 PM Tuesday – 9 AM
- 7:30 PM • Highly preferred to have Urgent care/Doctors’ office/Dental office experience Must have solid health insurance background.
Job Summary: · This position requires the full understanding and active participation in fulfilling the mission of.
· It is expected that the employee will demonstrate behavior consistent with our core values: Integrity, Accountability, Best Practices, Compassion and Synergy.
· The employee shall support ’s strategic plan and participate in and advocate performance improvement/patient safety activities.
· The Registration Representative is under the direction of the Supervisor/ Manager and is responsible for completing all registrations of patients presenting for procedures, admissions, outpatient and ER visits.
· The Representative must obtain and verify demographic and insurance information so that the patient can be accurately identified and billed for their services.
· The registration representative is responsible for collecting and posting the patient’s financial responsibility in Epic and immediately dropping the payment in the safe or locked cash drawer.
· Excellent customer service must be maintained with all patients, visitors, clinicians, and co-workers.
Skills: · Ability to communicate effectively in written and verbal form · Adheres to department policy of using two patient identifiers.
· Avoids HIPAA violations by choosing correct MRN and interviews, registers, and pre-registers patients timely and accurately in Epic.
· Ensures all registration forms are complete, signed, and scanned.
Enter notes in Epic as required.
· Ability to provide excellent customer service using Simply Better and AIDET principles.
· Collects and posts payments timely and accurately.
Immediately drops payment in safe or cash drawer.
· Ability to follow company policies, supports department performance improvement activities.
(Staff meetings, employee engagement survey, education, and training activities) · Maintains registration accuracy rate of 95% or better.
· Monitors and manages work queues.
· Ability to be at work and be on time.
Adheres to MHS time and attendance policy.
· Ability to follow company policies, procedures, and directives.
Supports department performance improvement activities.
(Meetings, employee engagement survey, education, and training activities) · Ability to interact in a positive and constructive manner.
· Ability to prioritize and multitask.
Essential Job Outcomes: · Adheres to department policy of using two patient identifiers ensuring correct information appears on all documents, armbands, and labels.
Adheres to a verbal verification of armband placement.
· Avoids HIPAA violations by accurately entering information into the Epic system to avoid passing on defects; such as incorrect patient name, PCP, guarantor and insurance information.
· Interviews, pre-registers and registers patients timely and accurately.
Appropriate level of expertise in Epic, OnBase, RTE, insurance websites to ensure accurate and efficient registrations.
· Ensures that all registration forms are complete, signed, scanned and indexed in Epic timely.
Enters notes in referral or auth/cert and uses billing indicator as needed.
· Delivers excellent customer service using “Simply Better” and AIDET principles with patients, staff, and visitors.
Maintains effective working relationships with co-workers and others.
Utilizing Simply Better recognition cards or any other communication regarding customer service.
· Collects and posts patient financial responsibility; including deposits, copays, deductibles, estimates, and/or coinsurance timely and accurately.
Drops payment in the safe or cash drawer timely.
Based on a monthly department cash collection goal.
· Participates in and supports department specific performance improvement education, training, staff meetings, and projects.
(Employee Engagement survey, service excellence, etc.) Promotes and participates in the employee engagement action plan).
Assists with improving the score.
· Maintains an accuracy of 95% or better by selecting the correct insurance plan and IPA code.
Monitors and manages assigned work queues to maximize productivity by meeting department standards.
Appropriate level of expertise in Epic, Onbase, RTE and insurance websites to ensure accurate and efficient registrations.
· Monitors assigned WQ’s to maximize productivity by meeting department weekly goals.
· Adheres to MHS time and attendance policy #357.
Clocks “in and out” of MTM accurately with minimal clocking errors for each scheduled shift.
Signs off by the end of the pay period.
· Other duties as assigned.
Experience: • 1-2 years of experience in hospital admitting, physician office, or equivalent healthcare • Must communicate effectively and clearly both verbally and in writing • Strong customer service skills • General knowledge of insurance payors: PPO, HMO, POS, EPO, Medicare, Medi-Cal, & CalOptima • Bi-lingual (English/Spanish, or English/Vietnamese) preferred • Positive work ethic • General computer skills required including electronic medical record and Microsoft Office • Knowledge of medical terminology
Not Specified
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