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Care1st Health Plan Jobs in Palmdale

Currently, there are no Care1st Health Plan jobs available in Palmdale, California. You may wish to explore jobs in nearby locations on the Care1st Health Plan jobs in California page or view related jobs below.
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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...

GENERAL SUMMARY: The Senior Claims Examiner is responsible for analyzing and adjudicating medical claims. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or CSIM (Customer Service Inquiry Module). Identifies root causes of claims payment e...

GENERAL SUMMARY: The primary responsibility of the case management nurse is to assist patients through the outpatient continuum of care in collaboration with the patient’s primary care physician and employing contracted ancillary service providers and community resources. The primary goal is to optimize member care in the ambulatory care setting to prevent/decrease emergency room visits and hospi...

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 evaluation 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 ...

GENERAL SUMMARY: Under general supervision of Claims Manager creates and maintains reports supporting all functional areas to include but not limited to Participating Provider Groups’ (“PPG”) authorization files and claims production and inventory. The Claims Reports Liaison will track the timeliness and accurate completion of the authorization files received from the PPGs. The Liaison creates an...