Location: Rancho Cucamonga, CA
Company: Inland Empire Health Plans
assisting Members with care coordination in respect to referral process such IPA for Durable Medical Equipment (DME), home health, and Specialist needs. 2. Responsible for assisting with the referral process by contacting providers by phone, fax, or email to request additional medical information as needed.
3. Responsible for assisting the Care Managers in the management and coordination of care of Member identified with care management conditions. 4. Responsible for facilitating Member care to ensure that a continuity of care letter of agreement (LOA) is executed when appropriate. 5. Collaborates on Member’s care issues with other team members and consults with NCM or CM supervisor to
ensure that appropriate treatment plan is followed, thoroughly and promptly. 6. Responsible for processing and coordinating divorces, disenrollment, transportations, and language interpretation as needed and applicable.
7. Assists with contact calls for monthly HRA pull, i. e. Complex Case Management and assisting with coordinating the members overall care as needed. 8. Responsible for identifying HEDIS gaps and contacting the member to address these gaps. 9. Responsible for covering Cisco ACD Queue telephone lines and Phone queue. 10. Assists with the coordination of access issues with PCP offices, specialists, radiology services and ancillary services such as PT, OT, speech therapies.
11. Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.
12. Consults with assigned nurses for clinical backssment and decision prior to taking action that are clinical in nature. 13. Performs any other duties as assigned or required to ensure Health Plan operations are successful. 14. Participates in Medical Services staff meetings or other activities as needed 15. Ensures the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance including attending annual compliance training. 16. Promotes a positive and collaborative working environment within the CM Team.
Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading: Self Experience Qualifications Two (2) years customer service experience in medical clinics, hospitals, or IPAs. Preferred Experience Managed care setting experience preferred. Education Qualifications High school diploma or GED required. Preferred Education Associate's degree or Bachelor’s degree from an accredited institution preferred. Professional Certification Medical Assistant Certification preferred. Professional Licenses Drivers License Required No Knowledge Requirement Knowledge of Utilization Management including referral process, ICD-10 and CPT codes preferred.
Knowledge of utilization management process and care coordination in HMO or managed care setting. Knowledge of Medi-Cal, and Medicare managed care. Understanding of and sensitivity to multi-cultural community. Skills Requirement Excellent written and verbal communication and interpersonal skills. Strong organizational skills, typing 45 words per minute, proficient in Windows applications. Experience in data entry. Abilities Requirement Team culture is a must. Telephone courtesy and high degree of patience.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Communication with IEHP Members, which includes intensive telephone use, basic computer knowledge and word processing/data entry skills including computer keyboard and screens, distribution of reports, filing and copying of records and/or correspondence.
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership. Work Model Location Telecommute Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Regular contacts: co-workers, supervisor - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $45,884.80 and $55,993.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.
” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Management & Executive Jobs refer to positions within an organization where individuals are tasked with making strategic decisions, overseeing operations, and leading teams towards achieving business goals. These roles typically include titles such as manager, director, vice president, and CEO, and are characterized by their high level of responsibility, authority, and often, a requirement for extensive experience and leadership skills. Executives set the vision for the company, while managers implement strategies and policies to drive success. These jobs often involve complex problem-solving, strong communication abilities, and the capacity to influence and motivate others.
Management & Executive Jobs refer to positions at the higher levels of an organization's hierarchy, involving significant responsibility over strategic planning, decision-making, and leadership. Executives set visions, goals, policies, and they often participate in high-level negotiations. Managers oversee the implementation of these directives, leading teams, managing resources, and ensuring operational efficiency. These roles demand strong leadership, communication, and analytical skills, as well as extensive experience in their respective fields. Typical titles include CEOs, CFOs, directors, and various department heads, each with a critical influence on the company's success and direction.
Management and Executive Jobs refer to positions at the higher levels of organizational hierarchy that involve overseeing operations, strategic planning, and decision-making. These roles typically include titles such as CEO, CFO, COO, department managers, and directors. Key characteristics of these jobs include leadership responsibilities, the ability to direct teams, craft strategic initiatives, and a focus on achieving company objectives through effective resource management. They generally require a combination of advanced education, extensive experience, and skills in communication, problem-solving, and critical thinking.
but are not limited to, health education and health management classes, workshops, and health screenings, as well as information regarding access to care. The Supervisor will be responsible for assisting to establish measurable goals and outcomes for the Center in collaboration with the Community Resource Center Manager.
Assist in the outreach of partnerships related to Center events and offerings to increase awareness in the surrounding community. Serve as the liaison/ambassador to internal and external clients/community partnerships. Responsible for the Center's activities calendar and ensuring appropriate and efficient utilization is maintained and lead in building and implementation
of Quality Assurance Program, instructor evaluation, curriculum design and metrics. Responsible for supervising all activities ensuring information flow to and from the Center and IEHP headquarter office.
Reviews and submits requests for payments, invoices, and other expenses for approval to the Community Resource Center Manager. NOTE: This position includes an Addendum to PART D: POSITION MAJOR FUNCTIONS which will oversee the Fitness Coach, Nutrition Coach and CRC programs. Major Functions (Duties and Responsibilities) 1. Meet or exceed daily/weekly/monthly goals for the Community Resource Center. 2. Responsible for all aspects of staff supervision to include creating a motivating and
energized work environment through strong leadership, communication, and organizational skills.
3. Responsible for maintaining and collecting quantitative and qualitative information and evaluative tracking data on Center activities. 4. Contributes to the development of the Center's operational and capital budgets and monitors for compliance and participates in the negotiation of and monitoring of contracts and subcontracts related to the Center and related activities. 5. Assist in the coordination of ongoing team meetings in addition to staff meetings with internal IEHP departments. 6. Recommends changes to policies and procedures based on Community Resource Center needs.
7. Assist Community Resource Manager in collaborating with management from Care Management, Member Services, Health Education, Health Navigator, or other departments when resolving Member issues or working on Program projects. 8. Ensure the standards for Member rights and responsibilities, such as confidentiality is maintained by staff. 9. Assist the Community Resource Manager in coordinating special projects. Ensure special projects are completed in a timely manner. 10. Nurture relationships with community-based organization partners who provide resources to families in the communities we serve.
11. Assist in the coordination of education/discussion forums surrounding various preventive health, or healthcare access topics in center territories. 12. Coordinate high volume projects/requests from multiple facets of the Community Resource Center. ADDENDUM – For Fitness Coach, Nutrition Coach and CRC Programs 1. Coordinate daily operational tasks in accordance with established Community Resource Center (CRC) policies and procedures, standard operating procedures, and job aids to ensure optimal performance results. 2. Supervise Team Members with planning, scheduling, and reviewing their scope of work while adhering to quality standards aligned with community resource center member experience.
3. Responsible for the hiring practices, training and developing, conducting performance reviews, communicate and implement the LEAN model to meet the standards, processes, and training to support growth and development. 4. Coordinate the curriculum design and oversight for the CRC’s programs, which includes MCAS/HEDIS related activities to support organizational goals, a quality assurance program and evaluation model to ensure effective services to Members and general community and provide a monthly completion of programming with calendar duties, in collaboration with the Marketing department for translation, print requests, and promotion on websites and social media.
5. Assist in reviewing usage of CRC facilities requests from external partners. 6. Facilitate and work with external partners to promote education, outreach of services and the importance of connections to the Community Resource Centers. Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications Two (2) years experience in the following: • Supervision/Lead Capacity • Managed Care/IPA/Clinic Setting • Community Outreach • Experience working with State Health Programs (Medi-Cal and Healthy Families Program) Preferred Experience Experience with Community Centers is a plus.
Education Qualifications Bachelor's degree, preferably in relevant health, social, or behavioral discipline, from an accredited institution required. Preferred Education Professional Certification Professional Licenses Drivers License Required Yes, must have a valid California Driver's license and valid automobile insurance.
Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points. Knowledge Requirement Understanding of and sensitive to multi-cultural communities. Knowledge of Medi-Cal/managed care environment preferred. Knowledge of community resources available in Riverside and San Bernardino Counties. Skills Requirement Bilingual (English/Spanish) written and verbal skills preferred. Must be fluent conversationally. Testing will be required to determine bi-lingual language level. Excellent computer skills with an emphasis on MS Office software.
Strong verbal, communication skill, and computer skills. Excellent time management, organization, and interpersonal skills. Strong verbal and written communication skills. Abilities Requirement High degree of patience. Ability to make clear presentations. Strong sound judgement and decision making. Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions Word processing and data involving computer keyboard, viewing monitor. Setting up and cleaning up for classes. Must be able to lift 40 lbs. High amount of field work with 25% driving travel required. Flexibility to work evenings and some weekends. Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Onsite Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $79,809.60 and $101,774.40, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
