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We're looking for candidates with great customer service skills to fill our Remote Customer Service role!. We're seeking someone who is great with people, building relationships, and putting customers first. Previous experience in customer service or sales is a plus.

We're looking for candidates with great customer service skills to fill our Remote Customer Service role! This role is entirely remote and offers full-time/Part time hours with flexibility . We are ready to schedule interviews for this week. We're seeking someone who is great with people, building relationships, and putting customers first. Our ideal candidate is eager to grow, ready to learn, and loves a fast-paced atmosphere. Language Requirement: Proficient level English Preferred experience/skills: • Previous experience in customer service or sales is a plus., • Great communication skills, • Ability to listen to and understand customer needs., • Good problem-solving skills, • Comfortable working remotely and independently, • Willingness to learn and develop new skills., • Ability to adapt to change in a dynamic environment., • If this sounds like you, we'd love to chat! What You Can Expect: • Flexible schedule, • 100% Remote position (Work from home), • Hands on training, • Life insurance, • Health insurance reimbursement, • Industry-leading resources and technology We hope to see your application soon!

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of between $25 / hr.There is no payment required in order to apply or to work as an In-Home Usage Tester.You

We're looking for candidates with great customer service skills to fill our Remote Customer Service role! This role is entirely remote and offers full-time/Part time hours with flexibility . We are ready to schedule interviews for this week. We're seeking someone who is great with people, building relationships, and putting customers first. Our ideal candidate is eager to grow, ready to learn, and loves a fast-paced atmosphere. Language Requirement: Proficient level English Preferred experience/skills: • Previous experience in customer service or sales is a plus., • Great communication skills, • Ability to listen to and understand customer needs., • Good problem-solving skills, • Comfortable working remotely and independently, • Willingness to learn and develop new skills., • Ability to adapt to change in a dynamic environment., • If this sounds like you, we'd love to chat! What You Can Expect: • Flexible schedule, • 100% Remote position (Work from home), • Hands on training, • Life insurance, • Health insurance reimbursement, • Industry-leading resources and technology We hope to see your application soon!

No customer service representative experience required. If needed, try out products or services ahead of your session. We're currently looking for individuals across the country to take part in remote paid market research, including online focus groups, product trials, and consumer studies.

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. NOTE- THIS IS 100% REMOTE ROLE & ONLY W2 CANDIDATES/NO C2C/1099 * Candidate must be authorized to work in USA without requiring sponsorship * Position: Utilization Review Nurse (Job Id -3146173) Location: Los Angeles CA 90024 (100% REMOTE) Duration: 3 Months + Possible Extension Job Description: We are seeking an experienced Utilization Management Review Nurse with a strong background in outpatient prior authorization within a health plan or managed care environment. The ideal candidate is a California licensed RN who can independently review clinical documentation, apply evidence based medical necessity criteria, and make sound authorization decisions in a high volume setting. This role requires confident communication with physicians, payers, and internal teams, strong critical thinking skills, and a solid understanding of Medicare, Medi Cal, and health plan utilization review requirements.The Utilization Management Review Nurse is responsible for the review and evaluation of clinical information and documentation related to prior authorization requests for medical services. Reviews documentation and interprets data obtained from clinical records or systems and uses clinical decision-making to apply appropriate clinical criteria and policies in line with regulatory, accreditation, and departmental requirements. Independently coordinates the clinical resolution with clinician/MD support as required. Acts as a resource for external teams such as customer service and claims. Utilizes advanced practice nursing skills in the assessment, education, and coordination of care for an identified group of patients. Collaborates and consults with the multi-disciplinary team, including but not limited to Physicians, Nursing, Ancillary, Professional, Technical, and other clinical and/or department team members along with patients and families to ensure safe and effective coordination of care. Participates in performance improvement projects/processes and other duties as assigned. Required Experience: • Current unrestricted Registered Nurse license in the state of California, • Minimum of 3 years of utilization management or prior authorization experience in an outpatient setting, • Direct experience performing prior authorization reviews for a health plan, managed care organization, IPA, MSO, or healthcare plan administrator, • Experience applying evidence based medical necessity criteria such as InterQual, Milliman, CMS, and health plan specific guidelines, • Demonstrated ability to independently review clinical documentation and determine medical necessity, level of care, approval, denial, or need for physician review, • Experience communicating medical necessity decisions to physicians, clinical staff, payers, and internal departments, • Strong background in abstracting and interpreting medical records to support utilization review decisions, • Working knowledge of Medicare, Medi Cal, and CCS utilization review requirements and regulations, • Experience collaborating with physician reviewers and interdisciplinary clinical teams to resolve authorization requests, • Proven ability to manage a high volume caseload in a fast paced remote or office based environment, • Must have prior authorization experience in an outpatient setting. (Must have health plan or healthcare plan administrator experience. Prior authorization nurse, clinical review nurse), • Current unrestricted RN licensure in CA, • 3-5 years’ experience in utilization management, preferred., • Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment., • Demonstrates resourcefulness, effective written and oral communication, diplomacy, organizational, and analytical skills (Required)., • Proficient knowledge in evidence-based medical necessity criteria, health plan medical necessity criteria and CMS criteria. (Required), • Strong critical thinking and the ability to apply knowledge, • Ability to work effectively and collaboratively with interdisciplinary teams., • Proficient computer skills including Internet search capabilities, Microsoft Word, Excel and Managed Care software (i.e. EZ Cap, Diamond, IDX). (Required), • Ability to effectively communicate to physician/staff the medical necessity/appropriateness/level of care criteria that is necessary for acute care hospitalization., • Ability to effectively communicate to the payer the medical necessity/appropriateness/level of care criteria that is necessary for acute care hospitalization., • Skill in setting priorities that accurately reflect the relative importance of job responsibilities., • Skill in abstracting and interpreting medical information from patient records., • Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of government programs such Medicare, Medi-Cal, and CCS., • Clinical experience sufficient to understand and communicate medical diagnosis and courses of treatment to professional and non-professional personnel., • Ability to develop an individualized case management plan that addresses physical, vocational, psychosocial, financial, and educational needs. Bhupesh Khurana Lead Technical Recruiter Email – Company Overview: Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward. Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws

Rewarding Employee Benefits (Insurance) Opportunity with a reputable, supportive and collaborative company! Hybrid position!! This Jobot Job is hosted by: Ba Tran Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $125,000 - $145,000 per year A bit about us: We are growing exponentially and have been recognized as one of the top companies within our industry! An accomplishment that we are very proud of and can attribute this to our exemplary employees and leadership team. With growth, comes opportunity to continue to add highly skilled and greatly valued employees to our organization. This is a very important hire for us as it is a vital position working with high net worth clients and we would really like this individual to provide the best in class customer service that we believe all of our clients and customers can expect from us. Feel free to apply and speak to us about the details of this opportunity! Why join us? • Competitive Compensation and Benefits Package, • Stable, long term, stability, • Join a well established team who is invested in your growth and success, • Substantial growth in their business Nationwide, • Rewarding work and responsibilities, • Hybrid Opportunity (2 days in office, 3 days remote a week) Job Details JOB DETAILS: We are seeking a dynamic and passionate Senior Employee Benefits Consultant to join our Sales team. The ideal candidate will serve as the primary business contact for our clients, ensuring their satisfaction through excellent customer service. This role involves building strong relationships with clients to encourage new and repeat business opportunities, managing at least $1 million in revenue. The Senior Consultant will lead client teams' projects, deadlines, and meetings, and oversee the execution of employee communication strategies, including the open enrollment process. RESPONSIBILITIES: • Lead client teams' projects, deadlines, and meetings, ensuring compliance with professional standards, • Develop and oversee the execution of employee communication strategies, including managing the open enrollment process, • Establish necessary carrier/vendor relationships to handle all administration of eligibility, claims, billing, plan implementation, contracts, plan changes, and necessary amendments, • Manage the request for proposal (RFP) process with health insurance carriers and internal underwriter and account managers, • Review, analyze, and interpret claim and utilization data from insurance carriers, and prepare customized reports for clients, • Create client presentations using Excel and PowerPoint, summarizing client data obtained from vendors or consultants, • Develop benchmarking reports by gathering health benefits data to compare a client's plan to other companies by industry or geography, • Review external vendor contracts, summary plan descriptions, and employee communications to ensure alignment with client expectations and legal requirements, • Recommend process improvements as needed, • A Life Accident & Health License from the state of domicile is required and must be maintained, • Advanced professional designation highly desirable (e.g., CEBS, CBP, etc.), • Bachelor Degree preferred. High School Diploma or equivalent required., • Minimum of 5 years’ account management experience in the insurance industry with a focus on Accident and Health lines of coverage is required, • Exceptional understanding of the lines of coverage for employee benefit plans: medical, dental, life, long-term disability (LTD), short-term disability (STD), accidental death and dismemberment (AD&D), vision, etc., • Exceptional knowledge of the rules and regulations associated with HIPAA, COBRA, Health Care Reform, and all other legislation and compliance related areas to Group Health programs, • Exceptional knowledge of insurance markets, products, services, insurance ratings, and underwriting procedures, • Outstanding interpersonal and communications skills are required to maintain effective relationships with clients, co-workers, carriers, vendors, and others, • Advanced skills in Microsoft Office (primarily Excel, PowerPoint, and Word), • Ability to work independently with limited daily supervision and to work effectively in a team environment Interested in hearing more? Easy Apply now by clicking the "Apply" button. Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy

Accept customer calls and return customer. Handle incoming customer service calls. Dispatch incoming customer phone calls.

Call Center / Customer Service / Remote] - Anywhere in U.Competitive pay / Medical, dental & vision / 401k match / PTO - As a Customer Support Specialist, you will: Answer inbound patient calls in a high-volume call center environment, providing assistance billing questions; Document customer intera

Call Center / Customer Service / Fully Remote] - Anywhere in U.Competitive pay - As a Customer Support Rep you'll: Manage large amounts of incoming phone calls; Identify and assess customers' needs to achieve satisfaction; Build sustainable relationships and trust with customer accounts through open

Customer Service / Remote] - Anywhere in U.Up to $26 per hour / Flexible schedules / Health, dental & vision / 401k / PTO - As a Call Center Scheduling Coordinator, you will: Actively communicate via phone, email, and Google Chat with ABA therapists, clients, and other team members to coordinate sch

Customer Service / Remote] - Anywhere in U.Up to $23 per hour / Medical, dental & vision / 401k / PTO - As a Call Center Rep at SCA Health, you will: Take inbound calls from patients and make outbound calls to patients; Provide one call resolution to patient inquires whenever possible and perform ti

Customer Service Rep / Remote] - Anywhere in U.Up to $56k-yr / Multiple Shifts Available - As a Contact Center Associate - FT - Work From Home, you will: handle incoming calls and emails from customers regarding ticket purchases and reservations; provide exceptional customer service by addressing an

Customer Service / Fully Remote] - Anywhere in U.Competitive pay / $500 retention bonus / Medical, dental, and vision / 401K / PTO / Equipment provided / Paid training - As a Call Center Support Rep you'll: Receive a large volume of inbound phone calls; Assist with outbound call campaigns; Answer ge

Customer Service / Remote] - Anywhere in U.Medical, dental & vision / 401k match / PTO / Paid training - As a Call Center Advocate at Lantern, you will: Call members to inform them of their benefits; Act as a care guide on behalf of the customer, helping them receive treatment from a network of high

Customer Service / Remote] - Anywhere in U.Health, dental & vision / 401k match - As a Call Center Rep at Orangetheory Fitness, you will: Place outbound calls to new leads and former members to schedule introductory classes; Follow up with leads using call cadences, scripts, and studio promotions; C

Customer Service / Remote] - Anywhere in U.Competitive pay & benefits - As a Call Center Rep at Jackson Hewitt Inc.Receive inbound/ make outbound calls to clients to learn about and address their needs, complaints, or other issues with products or services; Respond efficiently and accurately to clie

Customer Service / Remote] - Anywhere in U.Medical, dental & vision / 401k / PTO / Equipment provided - As a Call Center Associate at Vector Security, you will: Receive inbound communications from customers via multiple channels including phone, chat, email and text and provide positive customer exp

Customer Service / Remote] - Anywhere in U.Up to $69K per year / Free healthcare / 401k match / PTO - As a Customer Support Specialist at Snappy, you will: Manage a high volume of chat and email support inquiries with empathy, clarity, and speed; Host live Zoom and phone sessions for platform walkth

Customer Service / Remote] - Anywhere in U.Competitive pay - As a Customer Support Rep at Entrepreneur Babes, you will: Respond to customer inquiries and concerns in a timely and professional manner; Communicate with customers through various channels such as email, phone, and chat; Provide product

Customer Service / Remote] - Anywhere in U.Up to $25 per hour / Medical, dental & vision / 401k match / PTO - As a Customer Care Advocate at iRhythm Technologies, you will: Provide empathetic, personalized support to patients and providers, ensuring each interaction leaves individuals feeling heard,

Customer Service / Remote] - Anywhere in U.Up to $80K per year / Benefits - As a Customer Support Specialist at Runway, you will: Provide exceptional customer service through various communication channels such as phone, email, and live chat; Respond promptly and professionally to customer inquiries

Customer Service / Remote] - Anywhere in U.Up to $29 per hour / Medical, dental & vision / 401k match - As a Customer Support Specialist at AIA Contract Documents, you will: Respond to customer inquiries via phone, email, chat, and social media in a timely and professional manner; Use Zendesk (or ot

Call Center / Remote] - Anywhere in U.Competitive pay + performance-based incentives / Paid training / Medical, dental & vision / 401k / PTO - As a Customer Service Rep at Sagility, you will: Provide exceptional customer service to clients through various communication channels such as phone, email,

Customer Support / Remote] - Anywhere in U.Competitive salary / Health, dental & vision / 401k - As a Customer Service Rep at Curri, you will: Facilitate deliveries from booking to successful drop-off and everything in between; Provide best-in-class support for our customers and drivers via chat and

Customer Support / Remote] - Anywhere in U.Medical, dental & vision / 401k - As a Customer Service Rep at DGI Supply, you will: Handle customer and sales interactions via phone, email and tickets within the Customer Care Box; Process requests for quotations, order entry and product questions from cu

Customer Support / Remote] - Anywhere in U.Up to $50K per year + bonus / Medical, dental & vision / 401k match / PTO - As a Customer Service Rep at Legrand, you will: Process customer orders via phone, email, fax, EDI, and other channels; Provide accurate pricing, availability, and scheduling inform

Customer Service / Remote] - Anywhere in U.Up to $60K per year / Medical, dental & vision / 401k / PTO - As a Customer Support Associate at Equip, you will: Provide prompt, courteous, and efficient support to internal or external users experiencing product issues or seeking assistance with our softw

Customer Service / Remote] - Anywhere in U.Training provided - As a Customer Care Rep at Skygen, you will: Service our Dental and Vision inbound callers with information regarding their eligibility, benefit coverage, authorizations, claims, and locating a provider in their area; Ensure all calls are

Call Center / Remote] - Anywhere in U.Competitive pay / Medical, dental & vision / 401k / PTO - As a Customer Service Rep at Independence Pet Holdings, you will: Respond to 70-90 phone calls per day, providing exceptional customer service in every interaction; Answer customer emails promptly, addres

Customer Service / Remote] - Anywhere in U.Up to $21 per hour / Medical, dental & vision / 401k match / PTO - As a Customer Relations Specialist at GN ReSound, you will: Handle consumer inquiries via phone and email regarding manufacturer policies and product information; Direct consumers to Hearing

Customer Service / Remote] - Anywhere in U.Up to $42K per year + bonuses / Medical, dental & vision / 401k / PTO - As a Member Service Coordinator, you will: Conduct member outreach (telephonic, text and email) to schedule and confirm appointments; Effectively leverage practice management systems, E

Customer Service / Remote] - Anywhere in U.Competitive pay / Medical, dental & vision / 401k match / PTO - As a Customer Experience Specialists at Spot and Tango, you will: Provide timely and effective resolution to customer inquiries and concerns through phone, email, chat, and social media platfor

Customer Service / Remote] - Anywhere in U.Up to $54K per year / Medical, dental & vision / 401k / PTO - As a Customer Experience Rep at BRUNT, you will: Provide excellent customer service to clients by responding to inquiries and resolving issues in a timely and professional manner; Maintain a high

Customer Service / Remote] - Anywhere in U.Medical, dental & vision / 401k / PTO - As a Customer Experience Specialist at GOAT Group, you will: Provide exceptional customer service to our clients through various channels, including phone, email, and chat; Resolve customer inquiries and issues in a t

Customer Service / Remote] - Anywhere in U.Health, dental & vision / 401k match / PTO - As a Customer Support Specialist, you will: Provide timely and effective customer support through various channels such as phone, email, and chat; Document and track customer interactions and issues; Troubleshoot

Customer Service / Remote] - Anywhere in U.Up to $66K per year / Flexible hours / Health, dental & vision / 401k / PTO - As a Customer Care Coordinator at Sword Health, you will: Provide exceptional customer service to clients and ensure their needs are met in a timely and professional manner; Manag

Customer Service / Remote] - Anywhere in U.Up to $55K per year / Comprehensive benefits - As a Care Experience Specialist at Charlie Health in the Customer Service sector, you'll: Communicate effectively and compassionately with clients and their families; Provide timely and accurate information to

Customer Support / Remote] - Anywhere in U.Medical, dental & vision / PTO / Paid training - As a Customer Service Rep at Assurant, you will: Handle inbound customer calls and/or e-mails with empathy and professionalism; Resolve issues, answer questions, and provide proactive solutions; Document inte

Customer Support / Remote] - Anywhere in U.Health, dental & vision / 401k match / PTO - As a Customer Service Rep at Ferguson, you will: Utilize your excellent communication skills to provide top-notch customer service to clients via phone, email, and chat; Solve customer inquiries and issues in a t

Job Description The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. The Health Plan of San Joaquin is now hiring an experienced and dedicated Director, Claims! Location: We are looking for someone who lives in our service area. (Must reside in California.) Remote: This is a remote position; however, must be able to attend quarterly onsite meetings, and as needed for business and community purposes. What You Will Be Doing: Under limited supervision, the Director of Claims is responsible for developing and overseeing the implementation of strategic and operational objectives and plans consistent with internal and external requirements, best practices, and HPSJ strategies and objectives. Work is varied and complex and requires a high degree of discretion and independent judgment. Supervises Claims Managers Claims Analyst Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships. Essential Functions: • Identifies, develops, plans and executes business strategies, collaborating with executives, peers and others to ensure effective integration; directs the development and implementation of department goals and actions plans, • Oversee routine and ad hoc internal and external audits and direct the development, implementation and monitoring of corrective action plans, • Develops and monitors quantitative and qualitative analyses of claims data, trends and forecasting; implements appropriate interventions, • Oversees preparation for and participate in regulatory audits and external review activities; develops and monitors corrective actions plans, • Develops or directs the development of policies; ensures the development and implementation of appropriate companion procedures, guidelines and other documents., • Proactively Identifies and develops strategies to address issues and trends with claims processing, • Ensure compliance with applicable laws and regulations, • Oversee the development, implementation and maintenance of the appropriate and required data, records, reports and other documentation, • Identifies and oversees the implementation of process improvement strategies, • Leads the development, implementation and maintenance of best practice methodology, including metrics; ensures dissemination and understanding among stakeholders, • Anticipates technology needs; oversees development and implementation; collaborates to improve or upgrade current technology solutions, • Develops and manages department budget, implements appropriate interventions, • Promote and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values, • Other duties as required. What You Bring: Knowledge, Skills, Abilities and Competencies Required • Expert knowledge of and ability to apply and facilitate the adoption of best practices., • In-depth knowledge of the principles and practices of claims operations., • In-depth knowledge of health plan functions and interactions and their impact on claims., • In-depth knowledge of regulations and procedures governing Medi-Cal and other state sponsored programs as they relate to claims., • In-depth knowledge of procedure coding and medical terminology, and their application in benefits; general medical policy benefits and exclusions, and industry standard payment practices., • In-depth knowledge of claims processing systems., • Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions., • Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems., • Decision quality: Makes good and timely decisions that keep the organization moving forward., • Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies., • Strong knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results., • Ability to create relevant department objectives, and create, execute and monitor business plans., • In-depth knowledge of internal and external audit processes, and the ability to effectively implement and maintain them., • Demonstrated ability to develop and manage realistic budgets., • Strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals inside and outside of the HPSJ., • Strong interpersonal skills with the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of HPSJ, • Strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, and maintain effective, high-performance teams., • Strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications., • Build networks: Effectively build formal and informal relationship networks inside and outside of the organization., • Organizational savvy: Maneuvers comfortably through complex policy, process and people-related organizational dynamics., • Persuades: Uses compelling arguments to gain the support and commitment of others., • Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities., • Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals., • Ensures accountability: Holds self and others accountable to meet commitments., • Drives results: Consistently achieve results, even under tough circumstances., • Strong project management skills, including the ability to manage organizational-wide projects to successful conclusions., • Manages ambiguity: Operates effectively, even when things are not certain, or the way forward is not clear., • Strong knowledge of change management theory, with ability to anticipate and implement effectively., • Strong customer service skills., • Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values., • Ability to supervise staff in a manner that maximizes employee performance and business results, which includes very strong coaching/counseling skills and ability to function as a mentor., • Ability to speak and be understood in English., • In-depth knowledge of QNXT core processing system. What You Have: Education and Experience Required • Bachelor’s Degree or related fields or equivalent experience; and, • At least four years as a manager in a health plan overseeing all aspects of claims administration; and, • At least six years Medi-Cal claims and Medicare experience; and, • Master’s degree. Licenses, Certifications Required • Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability. What You Will Get: HPSJ Perks: • Competitive salary, • Robust and affordable health/dental/vision with choices in providers, • Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays), • CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan, • Two flexible spending accounts (FSAs), • Employer-Paid Term Life and AD&D Insurance, • Employer-Paid Disability Insurance, • Employer-Paid Life Assistance Program, • Health Advocacy, • Supplemental medical, legal, identity theft protection, • Access to exclusive discount mall, • Education and training reimbursement in addition to employer-paid elective learning courses., • A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do., • A shorter commute – if you’re commuting from the Central Valley to the Bay Area., • Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects. Physical Demands Work may require frequent sitting, standing, and walking, constant repetitive motion, frequent talking and listening, closeup and distance vision requirements. Some work may require occasional travel based on the responsibilities of the position and business needs and occasional handling materials up to 50 pounds. Emotional/Psychological Demands Ability to cope with a fast-paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, emotional and sensitive situations. Work Environment Work may be performed in a remote, hybrid, or onsite setting depending on the requirements of the position and business needs. For roles performed remotely, employees are expected to maintain a secure, distraction-free workspace, and reliable internet connectivity consistent with company standards. We are an equal opportunity employer, and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit. HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics. Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.

Job Description The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. The Health Plan of San Joaquin is now hiring an experienced and dedicated Executive Director, Health Services! RN license required. Location: We are looking for someone who lives in our service area. (Must reside in California.) Remote: This is a remote position; however, must be able to attend monthly onsite meetings, and as needed for business and community purposes. What You Will Be Doing: Under limited supervision, the Executive Director of Health Services is responsible for overseeing the strategic direction across HPSJ Health Services consistent with contractual and regulatory requirements, and HPSJ strategies and objectives. Health Services functions include Utilization Management, Case Management, Behavioral Health & Social Work, Quality Management, Quality Improvement, Health Equity, Health Education, HEDIS & NCQA, Credentialing, and Grievance and Appeals. Work is varied, complex and requires a high degree of discretion and independent judgment. Supervises Directors of Health Services Managers of Health Services Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships. Essential Functions: • Oversee operational objectives and plans; ensures the development and implementation of associated business plans and tactics, • Anticipates the need for, develops, and implements relevant and effective programs for health services, based on regulatory requirements, opportunities, issues, and trends., • Oversee the development of relevant, timely and accurate internal and external reports., • Supports implementation of targeted interventions designed to eliminate health inequities, • Assists the Chief Health Services Officer in identifying medical service issues that have an impact on plan benefits and their administration; assists subordinate managers in resolving grievances, appeals, quality and other health equity related issues., • Oversee the review of quality concerns identified through the QI process and the implementation and monitoring of corrective action plans., • Oversee the preparation of and participate in regulatory audits and external review activities; oversee the development, implementation and monitoring of corrective action plans., • Oversee routine and ad hoc internal audits and corrective action plans to ensure practices adhere to applicable guidelines and HPSJ criteria., • Ensures collaboration among the health services team with a focus on the member care., • Promotes strong collaboration across Health Services, Medical Management and other departments to ensure that the Quality program meets or exceeds NCQA and CMS, DHCS and DMHC regulatory standards., • Collaborate with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ’s Quality Improvement and Health Equity Transformation Program goals and activities., • Serves as a representative and spokesperson for HPSJ in support of Quality and Health Equity with key county partners., • Participate in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand HPSJ’s influence on benefit design, regulations, and policy direction., • Leads or participates in internal and external committees., • Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission, and values., • Hires, develops, retains, and ensures that subordinate managers hire, develop and retain competent staff, coach and support staff development., • Promotes, and ensures that direct reports promote an environment that supports and encourages the adoption of HPSJ’s stated values., • Oversee the development and management of select Health Services department budgets. What You Bring: Knowledge, Skills, Abilities and Competencies Required • Expert knowledge of and proficient skills in administering clinical operations protocols., • Expert knowledge of regulatory requirements for Medi-Cal and Medicare pertaining to utilization management, case management and behavioral health., • In depth knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results., • In-depth knowledge of standard contract components and contract language specific to healthcare., • In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them., • In-depth knowledge of medical management information systems and their interrelationships., • Strategic mindset: ability to translate strategic concepts into actionable business plans., • Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations., • Very strong facilitation, negotiation and conflict resolution skills., • Strong skills in budget development and management., • Very strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, maintain effective, high-performance teams, and organize people and resources to solve problems and identify business opportunities., • Very strong interpersonal skills, with the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ., • Very strong oral and written communication skills, with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information., • Very strong presentation skills, with the ability to tailor presentations to a specific audience, and address and interact with large groups., • Strong customer service skills., • Intermediate mathematics skills, including basic algebra., • Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs., • Ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff., • Very strong coaching/counseling skills, including the ability to function as a mentor to management and employees., • Ability to handle confidential information with appropriate discretion. What You Have: Education and Experience Required • Bachelor’s Degree in nursing from an accredited nursing school; and, • At least six years in clinical operations in a healthcare setting; and, • At least six years progressively responsible leadership positions in healthcare setting; and, • Experience in an HMO or managed care setting; and, • Experience with government sponsored programs. Preferred • Master’s Degree in Nursing, • Master’s Degree in Business, Public Health or similar. Licenses, Certifications Required • Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability. What You Will Get: HPSJ Perks: • Competitive salary, • Robust and affordable health/dental/vision with choices in providers, • Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays), • CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan, • Two flexible spending accounts (FSAs), • Employer-Paid Term Life and AD&D Insurance, • Employer-Paid Disability Insurance, • Employer-Paid Life Assistance Program, • Health Advocacy, • Supplemental medical, legal, identity theft protection, • Access to exclusive discount mall, • Education and training reimbursement in addition to employer-paid elective learning courses., • A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do., • A shorter commute – if you’re commuting from the Central Valley to the Bay Area., • Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects. Physical Demands Frequent sitting, standing and walking, constant repetitive motion, frequent talking and listening, occasional handling of materials up to 50 lbs., closeup and distance vision requirements, occasional travel. We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit. HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics. Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.