MGR - REFERRALS, DELEGATION OVERSIGHT, UM COMPLIANCE- Full Time

Responsibilities Come and join the RMC Family! We have been in the community since . Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region.

Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development.

Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.

Riverside Medical Clinic is the best place to work, practice medicine, and receive care. SUMMARY : Manager with a health care system development and integration for the organization will be responsible for improving membership retention, quality of care, health outcomes, and regulatory compliance, and utilization of services as it relates to Quality Management programs.

Oversight of HMO referrals pre-certification and retroactive reviews, delegation oversight with contracted HMO Health Plans, and the Compliance team.

Assists with implementing strategies for best practices with audit preparation and planning, participating in health plan audits.

Ensuring compliance with timeliness of turnaround times and notifications to patients, and completion of appropriate documentation.

Ensure appropriate utilization of medical necessity guidelines, oversight of approval / denial process of pre-certification and retroactive reviews.

QUALIFICATIONS : To perform this job successfully, an individual must be able to perform each essential function satisfactorily.

The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

HOURS : Monday - Friday; 8 : 30am - 5 : 30pm Qualifications EDUCATION and / or EXPERIENCE : Associate degree from an accredited college or two years college required.

Four years related experience required with three to five years of program development, and Compliance experience required.

Must possess knowledge of delegation oversight, referrals / denials functions, and knowledge of regulatory standards issued by CMS, DMHC, and other governing bodies required.

CERTIFICATES, LICENSES, AND REGISTRATIONS : California RN license required. Benefit Highlights :

• Challenging and rewarding work environment.
• Competitive compensation and paid time off.
• Excellent Medical, Dental, Vision and Life Insurance Plans.
• K) with company match and discounted stock plan. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc.
• UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune;

and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.

S. States, Washington, D.C., Puerto Rico and the United Kingdom.