Providence is calling a Supervisor Utilization Management Regulatory Compliance to our Facey Utilization Management location in Mission Hills, CA.
In this position you will:
- Responsibleforthedaytodaymanagementofcomplianceandreportingrequirementsbetween FaceyMedicalFoundationUMDepartmentandthehealthservicesandcontractareasofthehealthplans.
- Responsibleformonitoringthe accuracyofthedocumentationofmember's letters (extensions,denials,carveoutandauthorizations),issuanceandtimelysubmission.
- Abletoidentify riskandcomplianceissues.
- Prepare trainingmaterialforallUMstaffinordertobecompliantwithallregulations.
- PolicyandProcedures updates.
- AssistAdministrativeDirectorofManagedCare,UM casemanagerSupervisor,ContractManager,CaseManagers,RequestSpecialistSupervisorandUMstaffasneeded.
Required qualifications for this position include:
- Experiencein complianceaudits.
- Knowledge ofHMOprocesses,benefits,ICD-9/CPTcoding,medicalterminology,CMS,NCQA,DMHC,ICEandHIPPAKnowledgeofwordprocessing,Excel,anddata entry.
Preferred qualifications for this position include:
About the organization you will serve:
Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.
Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Supervisory / Management
Location: California-Mission Hills
Req ID: 148016