Job Description
Responsibilities
Come and join the RMC Family!
We have been in the community since 5. 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 : am - 5 : pm
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.
Pay Transparency :
To encourage pay transparency, promote pay equity, and proactively address regulations, UHS and all our subsidiaries will comply with all applicable state or local laws or regulations which require employers to provide wage or salary range information to job applicants and employees.
A posted salary range applies to the current job posting. Salary offers may be based on key factors such as education and related experience.
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