Santa Barbara Select is an Independent Physician Association (IPA) that functions under the Desert Physicians Management (DPM). DPM is a physician-owned managed care network with 200+ physicians and multiple urgent care facilities. Some administrative responsibilities include:
· Managed care operations
· Claims adjudication
· Utilization management
· Provider network administration
<Duties>
· Indicate eligibility and benefit findings on referrals and submit them to supervision for further processing
· Act as a point of contact for patient and provider calls regarding referral status checks
· Regularly maintain and report on DME Utilization, Home Health Utilization, Pharmacy Utilization, UM Utilization and turn-around times, and member services assistance on UM issues
· Coordinate with providers, specialists, patients, and internal departments to facilitate timely access to medically necessary services and follow up as needed
· Follow all UM/QM/CM policies and procedures, consistently applying the appropriate criteria for all UM decisions
· Ensure compliance with utilization guidelines, turn-around times, and regulatory timelines
· Monitor workflow queues to ensure timely processing of all referrals
· Conduct quality reviews for medical necessity
· Communicate approvals to clinics or providers
· Participate in Joint Operational Committees (JOC)
· Participate in ongoing staff training
· Participate in health plan audits
· Other duties as assigned
<Qualifications>
· Minimum two (2) - four (4) years’ experience in the healthcare management managed care environment required, including experience in managing, analyzing, and reporting denials and appeals.
This is a great opportunity to become a part of a growing organization that is dedicated to improving healthcare experience. Apply today and join us in our mission to deliver superior services, ensuring health and quality of life to the people in the communities we serve!
Equal Employment Opportunity (EEO)/Americans with Disabilities Act (ADA): We are an Equal Employment Opportunity (EEO) and Americans with Disabilities Act (ADA) compliant employer, committed to providing equal employment opportunity to all employees and applicants.
Pay: $22.00 - $32.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
