Prospect Medical Systems Jobs in California

50 jobs

Prospect Medical Holdings is searching for a qualified: CRC Regional Vice President – Los Angeles SUMMARY Job Summary: Lead the execution of the Los Angeles CRC strategy in cooperation with corporate and local delivery system executive leadership and work with local IPA and hospital staff to assure that it is executed in order to achieve clinical integration between our owned hospitals and owne...

Personal Care Coordinator/ Medical Assistant Prospect Medical is seeking Medical Assistants who are energetic and articulate who possess great critical thinking and strong managed care or care management experience with excellent computer skills to work as Personal Care Coordinators in a dynamic, forward thinking and cutting edge company. JOB SUMMARY: This position of Personal Care Coordinator ...

Prospect Medical is searching for a qualified: PDR Coordinator SUMMARY This position is responsible for conducting all pertinent research in order to evaluate, respond, and resolve incoming Provider Disputes accurately, timely, and in accordance with all established regulatory guidelines. ESSENTIAL DUTIES: include but not limited to Review and process all incoming Provider Disputes and appeal...

Prospect Medical is searching for a qualified: Claims Examiner III SUMMARY Responsible for consistently and accurately adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy. Process claims according to all CMS and DMHC guidelines. Examiner III will review, research and process complex claims. Handle recalculation of claims due to incorrect ...

Prospect Medical is searching for a qualified: Quality Improvement Nurse SUMMARY Oversees the daily operations of the QI department and is responsible for the execution and coordination of all QI activities. Interfaces with other departments and Health Plans for QI issues. ESSENTIAL DUTIES include, but are not limited to: Quality, Grievance and Appeals / Statistical Reporting: Review daily g...

Prospect Medical is searching for a qualified: High Intensity Case Manager SUMMARY Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to...

Prospect Medical is searching for a qualified: Pharmacy Coordinator SUMMARY Process drug orders and manage inventory control. Assist Pharmacists and DME/Ancillary Coordinator with authorization requests for injectable and infused medications. Maintain an atmosphere of professionalism and confidentiality. ESSENTIAL DUTIES AND RESPONSIBILITIES The following are included but not limited to: · H...

Prospect Medical is searching for a qualified: Patient Care Coordinator SUMMARY Prepares all referrals and coordinates them for review or denial. Assist the Referral Nurse and Medical Directors daily with additional information needed or benefit verification. Responsible for maintaining stat line. Documents pertinent information in Cerecons and IDX referral system. ESSENTIAL DUTIES AND RESPONS...

Prospect Medical is searching for a qualified: Case Manager Summary Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health n...

Prospect Medical is searching for a qualified: Patient Scheduler (Bilingual) SUMMARY This position is responsible for calling and scheduling senior patients for their wellness exams, translating English to Spanish documents, assisting with mailings to patients, and viewing EHR chart notes and calling patients for reminders. ESSENTIAL DUTIES include, but are not limited to: · Schedule annual w...

Prospect Medical is searching for a qualified: Patient Care Coordinator SUMMARY Prepares all referrals and coordinates them for review or denial. Assist the Referral Nurse and Medical Directors daily with additional information needed or benefit verification. Responsible for maintaining stat line. Documents pertinent information in Cerecons and IDX referral system. (please note - this is curre...

Prospect Medical is searching for a qualified: Claims Auditor SUMMARY To perform analysis and monitor trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple ...

Join a company that is committed to a long-term strategy and growing nationwide. Prospect Medical is searching for a qualified: Corporate/ Healthcare Recruiter The Corporate Recruiter is responsible for delivering all facets of recruiting success throughout the organization. This will be achieved by developing and executing cost effective traditional as well as creative sourcing, recruiting and...

Prospect Medical is searching for a qualified: Medical Assistant – Front Office SUMMARY This position is the first point where contact is made personally or by telephone. The person will receive the patient and direct them to the services needed. Making appointments and making preliminary assessment category of payment for patients are essential before provider can see them. ESSENTIAL DUTIES i...

Prospect is looking for the ideal candidate to fill our positions: Case Manager / Inpatient Concurrent Review Nurse As Inpatient Concurrent Review Nurse, You are responsible for coordination of daily inpatient services and discharge planning function in accordance with Prospect Medical Group policies, procedure and processes. Interacts with the Medical Directors and hospitalists on a daily bas...

Prospect Medical is searching for a qualified: SR. SQL Developer SUMMARY The SR. SQL Developer creates solutions for a variety of business problems. Develops the plan to design solutions, code, and test modifications and enhancements to the existing systems with a high level of reliability and execution speed. Provides assistance to the user community during the implementation of the system or ...

Prospect Medical is searching for a qualified: Nurse Practitioner / Physicians Assistant Job Summary: As Nurse Practitioner, you will be responsible for all aspects of patient care, diagnosis, treatments, consultations, conducting physicals and check-ups, ordering and performing various tests, providing general and preventative care, treating illnesses, and collecting family history information...

Prospect Medical is searching for a qualified: Manager, Benefits Configuration SUMMARY The Benefit Supervisor oversees the Benefit Department. Areas of responsibility also include staffing, scheduling, system configuration and auditing. Position also interprets and configures the financial risk matrix for each health plan into the IDX system. The position will also be a lead role for the proje...

Prospect Medical is searching for a qualified: Director of Provider Network Management for Los Angeles County Location: Los Angeles County or Orange County SUMMARY Responsible for achieving an operating budget, quality benchmarks, membership targets and physician development goals, while ensuring quality and satisfying service to members, physicians and provider partners. Develops and implemen...

Prospect Medical is searching for a qualified: Director of Provider Network Management for Inland Empire SUMMARY Responsible for achieving an operating budget, quality benchmarks, membership targets and physician development goals, while ensuring quality and satisfying service to members, physicians and provider partners. Develops and implements strategic expansion plans, executes revenue-drive...