- Serve as the UM Compliance Specialist with Delegated Health Plan contacts for reporting deliverables. Track due dates and deliverables.
- Assist UM Lead Compliance Specialist with development of policies and procedures, program plans, and work plans for IHP/IHHMG.
- Assist in the organization of internal and external audits, compile requested documents for UM IHP/IHHMG regulatory audits, manage audit repositories and maintain master audit dashboard. Track due dates and deliverables.
- Schedule meetings for UM projects and/or regulatory audits.
- Assist in developing presentations/reports for UM.
- Acts as a resource to staff, providers and/or members for UM program information.
- Adheres to payroll policies and properly uses a timekeeping system with minimal manual changes.
- Maintains regular and consistent attendance.
- Adheres to Compliance Plan and HIPAA regulations.
- Other duties as assigned to support regulatory compliance.
- Excellent planning and organization skills to track competing internal/external priorities.
- Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.
- Willingness and ability to follow written and verbal direction in English.
- Willingness and ability to maintain appropriate level of confidentiality and privacy.
- Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
- Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
- Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
- Ability to effectively prioritize items/tasks as required.
- Willingness and ability to take initiative and be a self-starter.
- Willingness and ability to understand and comply with Federal, State, and local regulations.
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Vast Long Beach, United StatesAt Vast, our mission is to contribute to a future where billions of people are living and thriving in space. We are building artificial gravity space stations, allowing long-term stays in space without the adverse effects of zero-gravity. Our initial crewed space habitat will be ...
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First Foundation, Inc. Pasadena, United StatesThis position is responsible for overseeing the adherence of the Bank's policies and procedures to federal and state laws and regulations. Salary Range: The salary range in CA for this role is $71,600/yr to $101,600/yr and represents the Company's go Compliance Specialist, Compli ...
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McKinley Children's Center San Dimas, United States**McKinley**:Youth, Family, and Community are what we are all about We offer a great working environment and benefits package McKinley encourages growth so that you can Be your Best H.U.M.A.N. · At McKinley employees share a set of guiding principles: We embrace a culture that is ...
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First Foundation Inc. Pasadena, United StatesSummary: This position is responsible for overseeing the adherence of the Bank's policies and procedures to federal and state laws and regulations. · Salary Range: The salary range in CA for this role is $71,600/yr to $101,600/yr and represents the Company's good faith minimum an ...
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Sr. Compliance Specialist
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First Foundation Pasadena, United StatesSummary: This position is responsible for overseeing the adherence of the Bank's policies and procedures to federal and state laws and regulations. · Salary Range: The salary range in CA for this role is $71,600/yr to $101,600/yr and represents the Company's good faith minimum a ...
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First Foundation Bank Pasadena, United StatesJob Description · Job Description · Summary: · This position is responsible for overseeing the adherence of the Bank's policies and procedures to federal and state laws and regulations. · Salary Range: · The salary range in CA for this role is $71,600/yr to $101,600/yr and re ...
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McKinley Children's Center San Dimas, United States**McKinley**:Youth, Family, and Community are what we are all about We offer a great working environment and benefits package McKinley encourages growth so that you can Be your Best H.U.M.A.N. · At McKinley employees share a set of guiding principles: We embrace a culture that is ...
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MST Insurance Solutions, Inc Torrance, United States**Job Title**:Compliance Specialist · **Classification**: Full-Time, Exempt · **Department**: Employee Benefits · **Location**:Hybrid/Torrance, CA · **Reports to**:Vice President of Employee Benefits · **Overview** · The Compliance Specialist is responsible for providing guidance ...
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Cross Country Healthcare Woodland Hills, United StatesCross Country is looking for top talent to join our team Cross Country is a market-leading, tech-enabled workforce solutions and advisory firm with more than four decades of industry experience and insight helping clients tackle complex labor-related challenges. Diversity, equali ...
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Utilization Management Compliance Specialist
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Imperial Health Plan of California, Inc. Pasadena, United StatesJOB SUMMARY: Support the Utilization Management (UM )Program and required regulatory deliverables for Imperial Health Plan of California, Inc. / Imperial Health Holdings Medical Group. May support the NCQA Accreditation Program and oversight processes, accreditation best practice ...
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Utilization Management Compliance Specialist
2 weeks ago
Imperial Health Plan of California, Inc. Pasadena, United StatesJOB SUMMARY: · Support the Utilization Management (UM )Program and required regulatory deliverables for Imperial Health Plan of California, Inc. / Imperial Health Holdings Medical Group. May support the NCQA Accreditation Program and oversight processes, accreditation best pract ...
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Utilization Management Compliance Specialist
2 weeks ago
Imperial Health Plan Of California Inc. Pasadena, United StatesJOB SUMMARY: · Support the Utilization Management (UM )Program and required regulatory deliverables for Imperial Health Plan of California, Inc. / Imperial Health Holdings Medical Group. May support the NCQA Accreditation Program and oversight processes, accreditation best pract ...
Utilization Management Compliance Specialist - Pasadena, United States - Imperial Health Plan Of California Inc.
Description
JOB SUMMARY: Support the Utilization Management (UM )Program and required regulatory deliverables for Imperial Health Plan of California, Inc. / Imperial Health Holdings Medical Group. May support the NCQA Accreditation Program and oversight processes, accreditation best practices and on-going training activities.
ESSENTIAL JOB FUNCTIONS:
MARGINAL JOB FUNCTIONS:
Takes on special projects as needed and requested.
Performs other duties as assigned.
BEHAVIORAL EXPECTATIONS:
Continuous Learning
Attends staff meetings as required.
Attends appropriate training, seminars and workshops as required.
Customer Focus:
Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMASs Standards of Conduct.
Fosters appropriate communication and relations with Supervisor, co-workers, and other staff.
Quality/Process Improvement/Safety
Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.
Supports and demonstrates safety throughout all duties performed.
Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities.
POSITION REQUIREMENTS:
EDUCATION/EXPERIENCE:
High school graduate or equivalent.
Bachelors Degree or equivalent combination of education and technical experience can substitute in lieu of degree.
SKILLS/KNOWLEDGE/ABILITY:
LICENSURE/CERTIFICATE/TRAINING:
n/a