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Riverside

    MGR - REFERRALS, DELEGATION OVERSIGHT, UM COMPLIANCE- Full Time - Riverside, United States - Universal Health Services

    Universal Health Services
    Universal Health Services Riverside, United States

    2 weeks ago

    Default job background
    Full time
    Description
    Responsibilities

    Come and join the RMC Family

    We have been in the community since 1935. 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.
    • 401(K) with company match and discounted stock plan.

    EEO Statement:


    All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.

    UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

    We believe that diversity and inclusion among our teammates is critical to our success.


    Notice:


    At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries.

    We take pride in creating a highly efficient and best in class candidate experience.

    During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email.

    The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at: or
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