Skip to main content

Care1st Health Plan Jobs in Carlsbad

Currently, there are no Care1st Health Plan jobs available in Carlsbad, California. You may wish to explore jobs in nearby locations on the Care1st Health Plan jobs in California page or view related jobs below.
Here are some related jobs:
GENERAL SUMMARY: Responsible for delivering high quality customer service to Plan members, providers and Plan personnel in an efficient, effective and timely manner. Responsible for dissemination of information regarding the Plan, benefit coverage and other necessary information, in addition to handling and following up on member complaints or grievances, transportation requests, member or provid...
GENERAL SUMMARY: Under the general supervision of the Behavioral Health Director, this position oversees Autism Spectrum Disorder Care Managers who provide telephonic triage and care management assistance to members with Autism Spectrum Disorders (ASD) including those accessing Applied Behavioral Analysis (ABA) benefit. QUALIFICATIONS: Masters degree in psychology or a related field. Possesses a...
GENERAL SUMMARY: Under the direction of the VP of Medical Services, the Medical Services Data Management Analyst is responsible for maintaining Medical Services Department compliance in data management and reporting for all UM, CCM, DM, MOC, MLTSS, and UMDO activities. This position involves assisting in the development and implementation of databases both independently or in collaboration with M...
SUMMARY: Under the direction of the VP of Medical Analytics, this position is responsible for working collaboratively with medical management, provider network operations (PNO), and management information services (MIS) to ensure that delegated preferred provider groups (PPG) submit timely encounter data; with an initial focus on encounter data necessary for state and federal regulatory reporting...
GENERAL SUMMARY: A Clinical Social Worker is involved in providing intensive social work services in serious and complicated cases. The work requires the flexible use of a wide range of highly skilled psychosocial assessment and intervention techniques to provide support and stabilization for members. The work involves in-depth assessments of family dynamics as well as interventions with members...
Under the direction of the Vice President of Performance Improvement, this position provides system programming analytical support to the Quality Improvement Department. The programming and analytics are focused on all Quality Programs, which include but are not limited to HEDIS, HCC, QIP, PIP, and PDSA workflow and submissions to regulatory agencies. This position serves as the principal program...
Department Summary: Care1st Health Plan is seeking an innovative, energetic, and motivated team player to add to our IT team. Job Purpose: The Database Administrator is responsible for the design, implementation, maintenance, and repair of the company’s internal SQL databases. The DBA will implement security measures and constantly monitor the performance of current systems; fine-tuning, upgradin...
GENERAL SUMMARY: The Director of Medicare Operations plans, organizes, implements and evaluates the Company’s Medicare Operations. Responsible for staffing and managing all departmental functions. Ensures effective cooperation and collaboration with other departments to implement and achieve organizational objectives and goals. Develops and implements programs related to Care1st’s Medicare produc...
GENERAL SUMMARY: The UMDO Data Coordinator (Coordinator) is responsible for the organization and tracking of IPA data submissions as it relates to UM delegated functions. The Coordinator will track IPA data submission via the Tracking Log and store the reports in the IPA Profiles. He/she will list non-compliant IPA in the Reconciliation Log. The Coordinator will ensure data submissions follow pre...
GENERAL SUMMARY: Complex Case Management (CCM) is responsible for coordinating resources, researching appropriate cost-effective alternatives/options for the catastrophic, chronically ill, identified high-risk members on a case by case basis to achieve realistic outcomes. The primary goal of the CCM is to optimize member care in the ambulatory care setting to prevent/decrease emergency room visit...
The Appeals & Grievance (A&G) Compliance Auditor assists the A&G Trainer/Auditor with the operations of the A&G Department and all A&G activities involving training compliance and auditing. The A&G Compliance Auditor audits, plans, develops, organizes and, monitors compliance to all A&G policies and procedures and regulatory requirements. The A&G Compliance Auditor reports to the A&G Supervisor a...
GENERAL SUMMARY: The UM Coordinator is responsible for supporting the UM Supervisor and UM Department activities. The UM Coordinator will screen all incoming authorization requests, verify eligibility and benefits, and complete the data entry portion of authorization in the CSC system. The UM Coordinator is delegated the responsibility of approving specific benefit authorizations QUALIFICATIONS:...
SUMMARY: Under the supervision of the Sr. Manager of Provider Network Operations, this position is responsible for maintaining good working relationships with internal business unites and Medical Groups/IPAs, hospitals, ancillary providers and direct providers. Manages complex issues and data integrity of the provider network to Care1st, regulatory (including to but not limited to LA Care) and acc...
GENERAL SUMMARY: Under minimal supervision, the Project Specialist I, in accordance with established policies and procedures, will assist with the development and implementation of Care1st’s new programs and product lines. In addition to program implementation, the Project Specialist I will utilize objective data analysis to perform program performance assessments and identify opportunities for o...
GENERAL SUMMARY: The UMDO Data Coordinator (Coordinator) is responsible for the organization and tracking of IPA data submissions as it relates to UM delegated functions. The Coordinator will track IPA data submission via the Tracking Log and store the reports in the IPA Profiles. He/she will list non-compliant IPA in the Reconciliation Log. The Coordinator will ensure data submissions follow pre...
GENERAL SUMMARY: The Credentialing Auditor is responsible for conducting IPA Due Diligence audits, tracking and analyzing IPA quarterly reports, collecting IPA rosters on an annual basis, attending Industry Collaboration Effort (ICE) meetings, and assisting with daily credentialing/re-credentialing activities as deemed necessary by the Credentialing Manager. QUALIFICATIONS: At least two years cre...
Supervise the daily operations of Claims Department and ensure projects are completed timely. Work with Claims Manager and/or Director to ensure compliance in all areas. Assists in monitoring of activities of claims administrative vendors. Responsible for work assignment, work schedules and prioritization. Collaborates with other departments and providers to resolve claims processing issues. QUAL...
GENERAL SUMMARY: Under the supervision of the Business Enrollment Supervisor, the Business Enrollment Lead assists with monitoring the daily functions of the Business Enrollment Unit and ensuring all Business Enrollment Unit guidelines are followed. As a liaison, he/she will advocate for the health plan and implement strategic enrollment and retention efforts to ensure the Business Enrollment Spe...