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SalaryWe’re delighted you’re considering joining us!
At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Join Our Team!
Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
DE&I Statement:
At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
Job Description:
This position reports to the Director of Utilization Management Prior Authorizations. This position works collaboratively with Utilization Management and Care Management leadership in the development and implementation of a comprehensive policy and procedure catalog for supporting compliance and UM functions. Hill Medical Group is a delegated physician model.
Job Responsibilities
- Develops policies and corresponding procedures to bring the department into compliance with regulatory and legislative, national, and state laws and mandates, including HPMG internal requirements related to Utilization management and compliance.
- Works with the Director of Utilization Management, Senior Director of Care Management, and the Compliance Department to monitor emerging regulatory requirements related to Utilization Management and collaborate with Utilization Management Operations Management on maintaining policies and implementing procedures.
- Develops systematic tracking mechanisms for updating key policies and procedures.
- Prepares and presents policies as required to regulatory oversight committees.
- Collaborates with appropriate stakeholders.
- Inputs and edits policies or procedures within compliance databases.
- Maintains annual review process of policies and procedures (and as needed by Health Plan directives).
- Responsible for capturing, synthesizing, prioritizing audit findings related to policy or procedure.
- Attendance at the HICE UM/QI workgroup quarterly
Required Experience
- 3+ years operational Project Management experience required.
- Associate or bachelor’s degree in health care administration, nursing, or related healthcare degree required.
- Ability to effectively work within a team environment, using excellent written, verbal and presentation skills to share audit findings, identify risk areas, compliance issues and develop proven strategies for improvement and compliance.
- Moderate or expert skills in Microsoft office suite required.
Preferred:
- Knowledge and ability to read and apply federal, national (Medicare), state (Medicaid) and NCQA accreditation mandated requirements, including health insurance coverage language preferred.
- Experience with the health plan audit process or delegation oversight preferred.
- Working knowledge and experience in Utilization Management and managed care operations and reimbursement concepts preferred.
- 5+ years of experience in quality, regulatory/compliance, or similar health care area of expertise preferred.
Required Education
- Bachelor or master’s degree in health care administration, nursing, or related healthcare degree preferred.
Salary: $102,500.00 - $134,850.00
Additional Information
Hill Physicians is an Equal Opportunity Employer
