Abrar Admin

1975

Duties &amp; Responsibilities:<ul><li>95% - Medical Review Support</li><li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li><li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li><li>Reviews requests for medical appropriateness for CBAS services utilizing Medi-Cal criteria or established policies and procedures.</li><li>Performs and/or reviews clinical assessments including California Department of Aging (CDA) approved standardized tools such as CBAS Eligibility Determination Tool (CEDT) and CBAS Individual Plan of Care (IPC).</li><li>Determines the appropriate decision regarding the service being requested for approval, modification or denial, and refers to the Medical Director when necessary.</li><li>Screens CBAS requests for Medical Director review, gathers pertinent medical information prior to submission to the Medical Director, communicates the Medical Director&rsquo;s decision with the requestor and documents follow-up in the care management system.</li><li>Initiates and follows through with contacting the member&rsquo;s caregiver, family, CBAS provider and treating physician as needed to obtain additional information for utilization review.</li><li>Complete all documentation accurately and appropriately for data entry in the care management system during authorization review, assessment and communication to include any authorization updates.</li><li>Accurately codes each diagnosis of service and procedures according to the established policy and procedure.</li><li>Analyzes all requests with the objective of monitoring utilization of services, which includes reviewing for medical appropriateness and identifying potentially high-cost complex cases requiring high-level case management intervention.</li><li>Establishes a means of communication with other team members, Medical Directors, community support providers including CalAIM and IHSS, and skilled nursing facilities.</li><li>Meets identified productivity and quality of work standards on an ongoing basis.</li></ul><ul><li>5% - Other</li><li>Completes other projects and duties as assigned.</li></ul>Minimum Qualifications:<ul><li>Associate degree in Nursing (ADN) PLUS 3 years of nursing experience with the health needs of the population served; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li></ul>Preferred Qualifications:<ul><li>1 year of authorization review experience.</li></ul><ul><li>Bilingual in English and in one of CalOptima Health&rsquo;s defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li></ul>Required Licensure / Certifications:<ul><li>Current unrestricted Registered Nurse (RN) license to practice in the state of California required.</li></ul>Knowledge &amp; Abilities:<ul><li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.</li><li>Work independently and exercise sound judgment.</li><li>Communicate clearly and concisely, both orally and in writing.</li><li>Work a flexible schedule; available to participate in evening and weekend events.</li><li>Organize, be analytical, problem-solve and possess project management skills.</li><li>Work in a fast-paced environment and in an efficient manner.</li><li>Manage multiple projects and identify opportunities for internal and external collaboration.</li><li>Motivate and lead multi-program teams and external committees/coalitions.</li><li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li></ul>Physical Requirements (With or Without Accommodations):<ul><li>Ability to visually read information from computer screens, forms and other printed materials and information.</li><li>Ability to speak (enunciate) clearly in conversation and general communication.</li><li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li><li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li><li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li></ul>Work Environment:If located at the 500, 505 Building or a remote work location:<ul><li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li><li>There are no harmful environmental conditions present for this job.</li><li>The noise level in this work environment is usually moderate.</li></ul>If located at PACE:<ul><li>Work is typically indoors in a clinical setting serving the frail and elderly.</li><li>There may be harmful or hazardous environmental conditions present for this job.</li><li>The noise level in this work environment is usually moderate to loud.</li></ul>If located in the Community:<ul><li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li><li>Employee will occasionally work outdoors in varied temperatures.</li><li>There may be harmful or hazardous environmental conditions present for this job.</li><li>The noise level in this work environment is usually moderate to loud.</li></ul>Pay: From $42.71 per hourWork Location: In person

Medical Case Manager, Community Based Adult Services

Office Assistant I &ndash; Job DescriptionPosition SummaryOffice Assistant I is an entry-level clerical classification responsible for performing routine administrative and office support tasks. Employees work under close supervision while learning departmental procedures and office operations.Essential Duties &amp; Responsibilities<ul><li>Perform routine clerical duties for the assigned department or program.</li><li>Type, proofread, and process basic documents including correspondence and forms.</li><li>Answer telephones and respond to inquiries from the public.</li><li>Provide information regarding department programs and procedures.</li><li>Issue and receive applications, permits, and other forms.</li><li>Assist with enrollment of participants in programs.</li><li>File, scan, copy, and maintain records and documents.</li><li>Enter and verify information in databases and records systems.</li><li>Sort and distribute incoming and outgoing mail.</li><li>Assist with meeting arrangements and office event preparation.</li><li>Maintain statistical records and assist with simple reports.</li><li>Perform other related clerical duties as assigned.</li></ul>Knowledge Requirements<ul><li>English grammar, spelling, punctuation, and basic writing skills.</li><li>Standard office procedures and equipment.</li><li>Basic arithmetic principles.</li></ul>Skills &amp; Abilities<ul><li>Perform routine clerical work including filing, proofreading, and data entry.</li><li>Verify and check records and data for accuracy.</li><li>Communicate clearly both orally and in writing.</li><li>Perform basic mathematical calculations.</li><li>Operate office equipment such as copiers, calculators, and fax machines.</li><li>Use computer software such as word processing, spreadsheets, and databases.</li><li>Build and maintain positive working relationships with coworkers and the public.</li></ul>Education &amp; ExperienceEducation: High school diploma, GED, or equivalent.Experience: No prior experience required.Office Assistant II &ndash; Job DescriptionPosition SummaryOffice Assistant II is the journey-level classification in the Office Assistant series. Employees perform the full range of clerical and administrative duties with minimal supervision. Positions are typically filled through promotion from Office Assistant I or by candidates with related experience.Essential Duties &amp; Responsibilities<ul><li>Perform general clerical duties related to the assigned department.</li><li>Type, proofread, and process documents such as correspondence, memos, and statistical charts.</li><li>Answer telephones and provide information to the public regarding department programs and policies.</li><li>Assist with enrollment of participants in department programs.</li><li>Process applications, permits, licenses, and other forms.</li><li>Process bills, record payments, and issue delinquent notices.</li><li>Collect and process fees and charges for permits and services.</li><li>Register participants in city programs.</li><li>Schedule inspections and appointments.</li><li>Perform routine clerical tasks including filing, copying, scanning, billing, and data entry.</li><li>Maintain alphabetical and cross-referenced filing systems.</li><li>Maintain statistical records and prepare simple reports.</li><li>Track program transactions and administrative records.</li><li>Assist with financial processing and program management tasks.</li><li>Sort and distribute mail and manage postage logs.</li><li>Order office supplies and process expense claims.</li><li>Assist with meeting arrangements and special event setup.</li><li>Perform other related duties as assigned.</li></ul>Additional Duties (Records Management Assignment)When assigned to records management, duties may include:<ul><li>Process records for storage or destruction according to retention schedules.</li><li>Maintain alphabetical and cross-referenced filing systems.</li><li>Track record retrieval requests and file movement.</li><li>Verify contents of records transferred for storage.</li><li>Input records information into the Electronic Document Management System (EDMS).</li><li>Prepare documents for scanning and maintain scanning logs.</li><li>Perform quality checks on scanned documents.</li><li>Assist with troubleshooting records imaging systems.</li><li>Provide guidance to departments regarding records management procedures.</li></ul>Knowledge RequirementsIn addition to Office Assistant I knowledge:<ul><li>Department procedures, operations, and program details.</li></ul>Skills &amp; Abilities<ul><li>Perform the full range of office assistant duties independently.</li><li>Use computers to produce reports, charts, spreadsheets, and documents.</li><li>Maintain databases and records systems.</li><li>Provide customer service to the public and internal staff.</li></ul>Education &amp; ExperienceEducation: High school diploma, GED, or equivalent.Experience: One year of clerical or administrative experience similar to an Office Assistant I role.Pay: $21.00 - $25.00 per hourApplication Question(s):<ul><li>Are you comfortable to do Mon-Thu 7:30AM- 6 PM Shift?</li></ul>Ability to Commute:<ul><li>Palmdale, CA 93550 (Required)</li></ul>Work Location: In person

Office Assistant I/II

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1975

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Medical Case Manager, Community Based Adult Services

Office Assistant I/II