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The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This enables us to create the health plan of the future and do our best work –Together.GCHP allows a flexible work environment so employees can work from a home location or in the office for all or part of their regular workweek (see disclaimer).GCHP’s focuses on our 5 Core Values:• Integrity• Accountability• Collaboration• Trust• RespectDisclaimers:• Flexible work schedule is based on job duties, department, organization, or business need.• Gold Coast Health Plan will not sponsor applicants for work visas.POSITION SUMMARYUnder the direction of the The Director, Provider Network Ops, Program and Policy, the Provider Contract Specialist III performs a range of duties including negotiations of provider contract terms, prepare contracts amendments and renewals, and perform provider rate analysis. You will prepare and disseminate information to appropriate stakeholders regarding contract status and necessary contract updates, renewal amendments, and terminations. To succeed in this role you need to detect the errors and inconsistences in contracts and have strong knowledge of standard provider contract boilerplates clauses as well as interpret contract language and rates in response to questions or claims resolution.Essential Functions StatementsReasonable Accommodations StatementTo accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.ESSENTIAL FUNCTIONS• Draft review, analyze and prepare various types of contracts, renewals and amendments according to regulatory guidelines and under appropriate legal supervision• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers as well as internal stakeholders• Assist in the development of pertinent policies and procedures pertaining to contract preparation and approval process• Manages detailed and organized electronic filing system for all contracts using applicable operational systems and keeps the system up to date.• Provider contract data reports and dashboards for management and stakeholders • Knowledge of provider credentialing and liase with key credentialing stakeholders• Perform rate analysis using rate analysis tool• Seeks legal and compliance assistance as appropriate through designated counsel in connection with proposed contractual arrangements and contract updates and revisions• Train Contract Specialist I and II as needed• Supports or leads state mandated provider network initiatives• Prepare and present training decks or presentationsQUALIFICATIONS• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.• Interpersonal - Ability to get along well with a variety of personalities and individuals.• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.• Communication, Oral - Ability to communicate effectively with others using the spoken word.• Communication, Written - Ability to communicate in writing clearly and concisely.SKILLS &amp; ABILITIESEducation: Bachelor's degree in related field or an equivalent combination of education and experienceExperience:• Minimum of 7 years of provider service experience and physician, hospital, ancillary, and health plan contracting• Minimum of 7 years of experience with varying payment methodologies and value base contracting, such as: Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case• Strong understanding of State of California Governmental Programs Contract Requirements and Reimbursement Methodology and Medicare Contract Requirements and Reimbursement Methodologies• Strong understanding of value based / risk based contracting arrangements• Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology• Proficient knowledge of legal requirements pertaining to relevant contractsComputer Skills:• Proficient in MS Office, Excel, Word Outlook and PowerPoint• Understanding SharePoint and metadataCertifications and Licenses: Valid CA Driver’s License<a href="https://www.click2apply.net/gAZNGZfpKAk44UMGyi62gO" target="_blank">Apply Here</a> PI253859935

Provider Contracts Specialist III

Job Title Nurse Clinical/Ambulatory/UKHC Requisition Number RE47889 Working Title Nurse Clinical Department Name H4007:Chief Medical Office Work Location Hybrid Grade Level 10 Salary Range $23.25-39.10/hour Type of Position Staff Position Time Status Full-Time Required Education ADN Click here for more information about equivalencies: <a href="https://hr.uky.edu/employment/working-uk/equivalencies" target="_blank">https://hr.uky.edu/employment/working-uk/equivalencies</a> Required Related Experience No experience required. Required License/Registration/Certification Registered Nurse (RN) Physical Requirements Maybe required to lift up to 50lbs. Shift 8:00am-4:30pm. This is a hybrid position. Job Summary The Care Manager (RN) position is a hybrid role, with a significant portion of the work conducted through home visits as part of an innovative initiative focused on advanced Transition Care Management. This role plays a crucial part in supporting patients with serious acute or chronic health conditions, as well as those seeking to maintain their wellness. The Care Manager will be a key member of multidisciplinary teams, working collaboratively to ensure comprehensive patient care. Through skilled assessments, personalized care plans, patient education, and clinical interventions, the Care Manager ensures continuity of care during transitions between healthcare settings, with a focus on promoting patient satisfaction and achieving optimal clinical outcomes. Home visits and other touchpoints allow the Care Manager to offer timely, patient-centered support. This position requires working closely with medical professionals in a fast-paced environment, balancing time and efficiency constraints, while maintaining a focus on quality, safety, and service. A solid understanding of nursing protocols, departmental procedures, and organizational policies is essential to thriving in this role and delivering excellent care to patients at home. Skills / Knowledge / Abilities Clinical assessment capabilities, care coordination, excellent communication skills, and health education teaching skills. Basic computer knowledge, MS Windows, Word, Outlook Does this position have supervisory responsibilities? No Preferred Education/Experience BSN Deadline to Apply 11/10/2024 Our University Community We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco &amp; Drug Free campus. As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities. Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Nurse Clinical/Ambulatory/UKHC

Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. <h4>Job Summary</h4>The Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for L.A. Care members. Utilizes assessments, member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available Health Plan, Home and Community Based Services (HCBS), and MLTSS resources, optimal member functioning, and cost-effective outcomes. Scope of work includes care coordination functions and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM). &nbsp;Collaborate with Skilled Nursing Facilities (SNF), &nbsp;Intermediate Care Facility - Developmentally Disabled (ICF-DD), Congregate Living Health Facility (CLHF), Community Based Adult Services (CBAS) Centers, Preferred Provider Groups (PPG), CalAIM providers (i.e. Community Supports, ICF-DD, Regional Center), cross functional units Behavioral Health to facilitate authorization of services. &nbsp;Coordinate the identification, documentation, and resolution of related issues in a timely manner.<h4>Duties</h4>Responsible for performing assessments of members referred to core MLTSS and other MLTSS administered programs for the identification, evaluation, coordination and management of members' needs, including physical health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior auths.&nbsp;Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary, to monitor, evaluate and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum. &nbsp;Arranges for all services required while coordinating with the health care team to eliminate duplication of services.&nbsp;Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS and other MLTSS administered &nbsp;programs.&nbsp;Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PPGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.Facilitates care coordination with internal and external entities to improve member's short and long term goals in collaboration with member, caregivers, family, support systems, and physicians. &nbsp;A person-centered approach will minimize member confusion, and ensure that the best care is delivered in the most appropriate setting.&nbsp;Performs clinical review of SNF and CBAS services and determines if the request is appropriate level of care. Reviews requests for PCHS and Respite to determine appropriateness of the request. &nbsp;Evaluates if needs can be addressed through other avenues, such as, community services, HCBS and covered health plan benefits, and makes referrals to appropriate programs.Documents accurately and comprehensively based on the standards of practice and current organization policies.Performs other duties as assigned. &nbsp;<h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4> Required:At least 5 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care. At least 3 years of relevant Licensed Vocational Nurse (LVN) experience may be substituted for 2 years of RN experience.Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment. Preferred:Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.<h4>Skills</h4>Required: Excellent verbal and written communication skills.Excellent organizational and time-management skills.Proficient in Microsoft Office.Preferred: Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.<h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4>Required: Registered Nurse (RN)<h4>Physical Requirements</h4>Light<h4>Additional Information</h4> Required: Travel to offsite locations for work.Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul> Nearest Major Market: Los Angeles Job Segment: LVN, Nursing, Registered Nurse, Travel Nurse, Behavioral Health, Healthcare

L.A. Care Health Plan

Managed Long Term Services and Supports Nurse Specialist RN II

<h4>How you'll change lives</h4>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.<h4>What you'll be doing</h4>Patient care. You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. Teamwork. You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.Safety &amp; Quality. Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.

U.S. Renal Care

Dialysis Registered Nurse - Long Beach Acute

<h4>How you will change lives</h4>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients. The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.<h4>What you'll be doing</h4>Patient care. You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.Technician Duties. You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.Safety and Quality. You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings.PATIENT CARE TECHNICIAN STATE SPECIFIC BOARD OF NURSING REQUIREMENTS California<ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul>Maryland<ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul>New Mexico<ul><li>Must have New Mexico dialysis technician certificate at time of hire OR</li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program OR</li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul>OHIO<ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul>OREGON<ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;

Dialysis Patient Care Technician MWF

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.<ul><li>A Home Therapy nurse trains home hemo or peritoneal dialysis patients in-center and sometimes in the patient’s home.</li><li>We Will Train - In-center hemodialysis, critical care, and home health are great backgrounds.&nbsp; </li><li>Work Schedule – Monday through Friday, 8am to 5pm; Modified schedules are possible based on patient caseload at the facility.</li><li>Competitive on-call pay when placed in on-call rotation. </li><li>Holidays – Home Training Nurses rarely work on a holiday. </li><li>We lead the industry in clinical quality improvement, delivering amongst the best patient outcomes in the U.S. as measured by the CMS ESRD Quality Incentive Program.</li><li>We remain an industry leader in home dialysis with 17% of dialysis treatments delivered in our patients' homes.&nbsp; </li></ul>The Home Therapy Registered Nurse, as qualified by federal and state regulations, provides patient training and ongoing support for all patients choosing a home dialysis modality.&nbsp; This position is accountable for providing quality care to all patients and is committed to delivering superior customer service in all internal and external interactions.&nbsp;&nbsp; &nbsp; ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.&nbsp; Other duties and tasks may be assigned.<ul><li>Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements as they pertain to home dialysis program and patient care requirements.</li><li>Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and state regulations governing Registered Nurse qualifications.</li><li>Conduct home visits to assess the patient's home environment per policy; initially and minimally annually thereafter.&nbsp; Routinely evaluate patient performance and assess the home environment more frequently as needed to improve care.</li><li>Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li>Document all nursing services in the Electronic Medical Record including but not limited to training sessions, routine and non-routine in-person interactions, and phone conversations.&nbsp; Documentation should accurately reflect the patient status and nursing interventions and be written to ensure continuity of care.</li><li>Participate in infection control monitoring, implementation, and recording as requested.</li><li>Be familiar with emergency equipment and all emergency operational procedures.&nbsp; Communicate and regularly review Emergency Preparedness procedures with all home patients, including but not limited to emergency disconnection from dialysis equipment, what to do and who to contact if displaced from home.</li><li>Ensure clinic and patient supply inventory and usage is appropriate for patient prescriptions and place orders in timely manner to avoid fees and penalties.</li><li>Continually seek to improve patient and quality outcomes through tracking and trending of program and patient performance, use of critical thinking skills and root cause analysis to improve patient and quality outcomes.&nbsp; Assist in obtaining data for the continuous quality improvement activities.</li><li>Obtain routine and non-routine laboratory tests as ordered and communicate critical lab values and urgent patient needs to the responsible physician or physician extender in a timely manner.</li><li>Complete and document monthly review of patient medication profiles.&nbsp; Administer medications as ordered by the physician.</li><li>Responsible for performing on call nursing services, nights and weekends, on a rotational basis as needed or assigned.</li><li>Flexible with staffing locations and hours to accommodate patient and USRC home program needs.</li><li>Regular and reliable attendance is required for the position.</li></ul>Home Hemodialysis Only:<ul><li>Coordinate home evaluation with technical services department to ensure that the necessary electrical, plumbing and drainage requirements for proper equipment operation are met prior to patient acceptance into home program.</li><li>Ensure required and appropriate water sampling is complete per policy and product requirements.&nbsp; Monitor and report water sample and culture results.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</li></ul>Salary / Compensation StatementCompensation for the role will depend on several factors, including a candidate's experience, qualifications and skills. U.S. Renal Care offers a comprehensive total rewards package, which includes a 401k match, healthcare coverage, and a broad range of other benefits.

Dialysis Registered Nurse, Peritoneal RN

Gold Coast Health Plan will not sponsor applicants for work visas.The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.POSITION SUMMARYUnder the direction of the Senior HR Manager, this multi-faceted role will provide support in all aspects of talent strategy and training needs of the organization. This includes goal planning, performance management cycle, employee engagement, learning and development, DE&amp;I and other areas. This role will also be responsible for supporting and driving HR projects from the beginning to completion while working with various stakeholders to ensure goals are met. This role will be the lead for the training function and provide additional support for various HR functions.Work Schedule: Hybrid work location home and office, typical office hours with some ability to extend time for critical projectsESSENTIAL FUNCTIONSReasonable Accommodations StatementTo accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions• Support talent management at GCHP to aim to attract, develop, retain, and optimize workforce. This includes performance management, employee and leadership learning and development, talent reviews, succession planning, employee engagement, career development, and more.• Lead project management of HR initiatives such as employee development programs, leadership development, talent reviews, performance review process, merit planning, org/structure succession planning, benefits programs and employee survey.• Lead weekly project meetings with HR team members for ad-hoc or cyclical HR initiatives, manage the project plans, capture action items, follow up and communications as needed• Lead the training function which includes assessing training needs of the org, creating training paths, training utilization improvement, monitoring training programs, collaborating with other departments to understand their specific training needs and help roll them out.• As needed manage logistics for training sessions, including scheduling, and resource allocation. This includes managing enrollment, communicating with participants about training schedules, and providing support to ensure a productive learning environment• Lead the administration of LMS systems, including creating/managing accounts, permissions, user activity, schedule trainings, maintenance and updates, and address questions and concerns.• Lead the administration of HR talent systems such as employee experience platform, LMS, etc.• Identify and analyze key talent management metrics such as training &amp; development, employee engagement, performance etc. to provide actionable insights that drive organizational effectiveness.• Support HR team initiatives as neededPOSITION QUALIFICATIONSCompetency Statements• Business Acumen - Ability to grasp and understand business concepts and issues.• Decision Making - Ability to make critical decisions while following company procedures.• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.• Interpersonal - Ability to get along well with a variety of personalities and individuals.• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.• Consensus Building - Ability to bring about group solidarity to achieve a goal.• Relationship Building - Ability to effectively build relationships with customers and co-workers.• Presentation Skills - Ability to effectively present information publicly.• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long range goals can be achieved.• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.• Judgment - The ability to formulate a sound decision using the available information.• Communication, Oral - Ability to communicate effectively with others using the spoken word.• Communication, Written - Ability to communicate in writing clearly and concisely.• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.SKILLS &amp; ABILITIESEducation: Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: Human Resources, Business Administration or related disciplineExperience:• 5 years of experience in Human Resources field• 2 years’ experience with HR training/administration and initiatives aligned with talent managementComputer Skills:• Experience with HRIS and LMS• Advanced MS Office skills specifically PowerPoint, Project Management and ExcelOther Requirements:• Strong project management skills and must have the ability gather business requirements and partner with the various stakeholders to plan, implement and improve solutions• Proven ability to maintain confidentiality• Excellent interpersonal skills including a professional and diplomatic demeanor• Ability to organize to think end-to-end and manage multiple long-term projects simultaneously• Ability to work autonomously and effectively• Ability to multitask several projects with a spirit of flexibility• Ability to grasp and understand business concepts and issues• Multi-tasking and prioritization skills will all levels of management<a href="https://www.click2apply.net/XjrKRWuV6LMpEHnBysjzJy" target="_blank">Apply Here</a> PI253555212

Senior Specialist, Talent Management & Training

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.Work Culture:GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).GCHP’s focuses on 5 Core Values in the workplace:• Integrity• Accountability• Collaboration• Trust• RespectDisclaimers:• Flexible work schedule is based on job duties, department, organization, or business need.• Gold Coast Health Plan will not sponsor applicants for work visas.POSITION SUMMARYThe Network Operations Sr. Specialist will liaise with healthcare providers and clients on healthcare-related issues, related to the GCHP processes, policies and procedures, contracting, reimbursement and the provider’s role in participating with governmental programs, including resolving queries and train healthcare providers to ensure operational efficiency. The Network Operations Sr. Specialist should be highly organized and have excellent communication skills.Reasonable Accommodations StatementTo accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.ESSENTIAL FUNCTIONSEssential Functions Statements• Initiating and maintaining effective channels of communication with GCHP network providers.• Effectively managing GCHP network providers, including participating in and leading joint operations meetings to help support company strategies and goals.• Managing and collaborating with Quality, Operational, Financial departments for reporting of GCHP network provider performance including analyzing data to determine trends, findings and recommendations.• Managing and collaborating with applicable departments on Corrective Action Plans resulting from performance and audit findings.• Training and investigating contracting questions, including interpretation of contract language as it pertains to the roles and responsibilities of a GCHP network provider, coding and reimbursement methodology.• Gathering, reviewing, and verifying, within the regulatory required timeframes, all pertinent information relating to GCHP network providers to ensure timely and accurate data and information for applicable operational systems.• Establishing and maintaining relationships with GCHP network providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.• Conducting mandatory and ad hoc training with GCHP network providers on policies, procedures, service lines, and available technology as well as tracking all provider engagement for regulatory reporting purposes.• Answering questions from GCHP providers to drive resolution.• Gathering, reviewing, and submitting relevant documentation needed for resolving complex claims inquiries and/or claims processing.• Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare with a focus on Medicaid and Medicare.• Identifying issues, shortfalls, and trends in GCHP provider network to help initiate improvement opportunities.• Manage and train on contract inquiries and/or contract issues that impact GCHP network providers’ roles and responsibilities.• Conduct regularly scheduled meetings with providers and resolve outstanding issues.MINIMUM QUALIFICATIONSEducation &amp; Experience:• High School Diploma or minimum of 8 years direct experience.• Bachelor's Degree (four-year college) preferred• At least 8 years health care/managed care experience in the health care field and at least minimum of 3 years of provider relations and/or provider network experience interacting directly with providers.• Understanding and experience with Governmental Programs (Medicare and Medicaid), direct experience with State of California MediCal is a plus.• Travel to multiple sites and different locations. Flexibility to work beyond normal business hours as needed.Equivalent In lieu of degree:• Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.• Minimum 8 years’ direct experience.• Four years of experience must be added in lieu of a bachelor’s degree when required.KNOWLEDGE, SKILLS &amp; ABILITIESPreferred Qualifications:• Five years preferred of provider relations and/or provider network experience interacting directly with providers.• Technology &amp; Software Skills: Advanced computer skills included in the MS Office products, specifically Word, Excel, PowerPoint, Teams and OutlookCertifications &amp; Licenses: A valid and current Driver's License, Auto InsurancePOSITION QUALIFICATIONSCompetency Statements• Management Skills - Ability to organize and direct oneself and effectively supervise others.• Initiative - Ability to make decisions or take actions to solve a problem or reach a goal.• Customer Oriented - Ability to take care of customer needs while following company procedures.• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.• Interpersonal - Ability to get along well with a variety of personalities and individuals.• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.<a href="https://www.click2apply.net/ZLZP6mu74PnakSRL5s6RAK" target="_blank">Apply Here</a> PI253554059

50 Healthcare / Pharmacy Jobs in California