Public Programs Coordinator

Health Net

(Los Angeles, California)
Full Time Evenings Weekends
Job Posting Details
About Health Net
Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable.
Summary
The Public Programs Coordinator is responsible for triaging and resolving member access to care issues and coordinating services with programs that are “carved out” of the health plan contract with the Department of Health Care Services, i.e. California Children’s Services and Regional Centers, as well as, promoting member access to Health Net’s Empower Living Program (H.E.L.P.) This position is also responsible for communicating and collaborating with internal and external customers to ensure access to care and services for Health Net members.
Responsibilities
- Researches, resolves, makes referrals and follows up with clients and agencies for access to care issues. - Collaborates with multiple Health Net Departments including, but not limited to, Member Services, Provider Network Management, Medical Management, Medical Review Unit, Pharmacy and Claims to resolve member issues. - Serves as Health Net's liaison to public agency programs and assists with referrals from the Participating Physician Groups (PPG) to the H.E.L.P Program. - Receives, researches and resolves coordination of care referrals from Customer Services. - Conducts escalated service coordination on complex cases and monitors through resolution. - Supports programs such as Regional Centers, School Health Integration and California Children's Services with in-person meetings to better understand and promote available services. - Researches and prepares conflict resolution documentation to support Appeals and Grievances. - Prepares and submits monthly and quarterly COC reports to compliance. - Performs other duties as assigned.
Ideal Candidate
**Education** * Associate's degree, completion of Vocational Nursing School, Medical Assisting or Pharmacy Technician Program **Certification/ Licensure Required** **Prefer one of the following:** * Current, valid and unrestricted California Medical Assistant Certification * Current, valid and unrestricted Licensed Vocational Nurse (LVN) license * Current, valid and unrestricted Pharmacy Technician Certification **Government Clearance & US Citizenship Requirement** * N/A **Knowledge, Skills & Abilities** * Knowledge of Medicare, Medi-Cal and publicly-funded health care programs in California * Excellent customer service skills * Ability to balance and prioritize multiple tasks * Must be willing to work and contribute in a team environment and flexible to change * Proficient computer skills using Microsoft Office applications * Strong written and verbal communication skills * Bilingual preferred **Experience Required** * Minimum three years clinical experience * Or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position. **Working Conditions** - The following section describes the general physical requirements for this position. Please note that constant refers to more than 81% of time; significant refers to 40-80%; and moderate refers to 20-40% of the time. - Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment. - Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations. - May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays). - May be required to maintain established work pace, meet deadlines; may have last minute urgent requests. - Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc. - Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned. - Required to have hearing ability to receive detailed information through oral communication. - Required to have speaking ability to express or exchange ideas - Constant concentration may be required on various subjects by listening, reading and thinking clearly. - Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions. - Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next. - Constant computer usage including typing and/or eye strain. - Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry). - Moderate phone usage; headsets may be required. - Constant amount of time spent working in a loud office environment with frequent interruptions/distractions. - Constant sedentary work (desk bound or seated). - Constant reading is required via computer screen and/or bound printed materials.

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