Jobs in Alhambra, California

Job Description: Claims Examiner will be responsible for adjudicating complex claims, manually and/or automatically price claims accurately, and identify billing issues. Responsibilities include, but not limited to: Analyze, research, and process and/or adjust claims with accurate use of procedures and ICD-10 codes under respective provider and member benefits based on:Contractual agreement Health Plan division of financial responsibility Applicable regulatory legislature Claims processing guidelines Client group’s and company’s policies and procedures Review and process facility (UB-04) and professional (CMS-1500) claims. Process Medicare member claims based on DMHC and DHS regulatory legislature Respond and resolve providers’ and health plans’ inquires in a timely manner Review services for appropriate charges and apply authorization Monitor aging claims with reports to maintain timeliness Maintain quality and productivity standards Participate in special projects Works closely with Supervisor and reports any issues Qualifications: • At least a high school diploma • Must have at least 3 years of applicable healthcare claims adjudication experience within a managed care industry • Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing. • Must be familiar with facility and professional claim billing practices. • Must have good written and communication skills. • Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment. • Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. Knowledge in EZ-CAP 6X is a plus. • Familiar with SSRS is a plus. • Typing skills of at least 40 wpm.

Overview: Clinic Director - Physical Therapist (PT) Make the Best Investment in Your Career Why is EmpowerMe different? We believe in therapists. That’s why we invest so heavily in their success — with extensive training, free CEUs, mentoring, and most importantly, a variety of paths for professional growth. Come build a future with us! Incentive Opportunities For some leadership positions at EmpowerMe Wellness, we offer financial incentive opportunities tied to performance. Be sure to ask your recruiter to learn more! Responsibilities: The Opportunity We are hiring a Physical Therapist (PT) to serve as Clinic Director at a senior living community that offers one or more of the following care settings: independent living, assisted living, and memory care. Therapy services for the residents at this community are covered by private insurance and/or Medicare Part B. As a Clinic Director, you will be responsible for: Overseeing how team members at your location(s) deliver care in accordance with federal, state, and local regulations Leading operational initiatives, including the implementation of company-wide policies, clinical programs, and quality initiatives Advising interdisciplinary care partners on treatment planning and therapeutic interventions Maintaining professional practices and ethical standards in accordance with company-wide policies and clinical initiatives As a PT, you will be responsible for: Providing physical therapy and wellness services for older adults Conducting assessments, treatment plannings, and therapeutic interventions Contributing to program development, quality improvement, and problem-solving Optimizing each patient’s functional well-being and satisfaction Your Schedule While our clinics typically operate 8 a.m. to 5 p.m. Monday through Friday, our flexible scheduling lets you craft a schedule that’s suited to your unique lifestyle! Our Amazing Benefits All Employees Get: Fun at Work, a Team You’ll Love, and a Culture You Can Stand Behind! 401(k) Eligibility with Opportunity for Matching Funds Amazing Career Advancement and Cross Training Opportunities Recognition Programs Employee Assistance Program Part-Time Employees Also Get: Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection) Full-Time Employees Also Get: Full Benefits, including HSA, FSA, and Life & Disability Insurance Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity, Identity Theft, Pet Protection) Flexible Paid Time Off You’re Our Perfect Fit If... You’re energetic, dedicated, and hard-wired to help others – especially seniors. You want to make a difference in the world and help others lead fuller, healthier lives. You want more than just a job…you seek a calling – a mission you can feel great about. And you want a support system to ensure your career ascends to the highest of heights. Plus, you have the following: Completion of an accredited Physical Therapy program (New Grads Welcome) ️ Current state licensure in PT Excellent verbal and written communication skills A results-oriented mindset with a dash of critical thinking Tech-savvy skills – quick learners are our favorite kind! ❔ Professional curiosity and a knack for finding solutions Come be a part of our mission to make a positive impact on the lives of seniors. Apply today! Qualifications: About EmpowerMe Wellness EmpowerMe Wellness is on a mission to improve the lives of seniors and the communities they call home! We provide fully integrated healthcare to senior living communities nationwide, offering on-site care coordination, therapy, and pharmacy services. Our experienced team of more than 3,500 clinicians and professionals provide personalized health and wellness solutions that lead to healthier, happier tomorrows! To learn more about us, visit empowerme.com today. This employer is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the employer will provide reasonable accommodations to qualified individuals with disabilities and encourages prospective employees and incumbents to discuss potential accommodations with the employer. Compensation: $47.00 - $63.00 per hour

At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. Everywhere. Every day. It’s a lofty goal; we know. But we make it happen with the best team in behavioral health. Thank you for taking the time to explore a career with us. As the fastest growing behavioral health practice group in the country, now is the perfect time to join our clinical team! We are actively looking to hire talented therapists in the area, who are passionate about patient care and committed to clinical excellence. Is this you? Wanting to deliver high quality behavioral healthcare. Seeking work life balance. Interested in growing professionally. What we offer Therapists: Competitive compensation at $117K to $134k based on productivity Flexible work schedules. Telemedicine and in-person flexibility. Full benefits package: health, dental, vision, life, 401k (with match), paid parental leave, EAP and more. Cash incentive bonus plan. Collegial work environment. Newly designed and modern offices. Full administrative support. Latest in digital technology. Strong work/life balance. Licensed Therapists are a critical part of our clinical team. We’re seeking Licensed Therapists that are: Fully licensed and credentialed in California LPCC / LCSW / LMFT Experienced in working with adult, and/or child and adolescent populations. For additional information about this opportunity contact Jackie.Kalpin@lifestance.com. About LifeStance Health LifeStance is a national provider of mental healthcare services focused on evidenced-based, medically driven treatment services for children, adolescents and adults suffering from a variety of mental health issues in an outpatient care setting, both in-person at its clinics nationwide and through its digital health telemedicine offering. The company employs psychiatrists, psychologists, psychiatric nurse practitioners, and licensed therapists throughout the US. LifeStance Health is an equal opportunity employer. We celebrate diversity and are fully committed to creating an inclusive work environment for all our employees. Our values: Belonging: We cultivate a space where everyone can show up as their authentic self. Empathy: We seek out diverse perspectives and listen to learn without judgment. Courage: We are all accountable for doing the right thing - even when it's hard - because we know it's worth it. One Team: We realize our full potential when we work together towards our shared purpose. If you elect to interact with us via our website, please only use www.lifestance.com or www.careers.lifestance.com. Additionally, our recruiters utilize email addresses with the @lifestance.com domain. Other websites and domains are not affiliated with LifeStance Health and may represent threats to your data security.

Are you a person who believes in providing great care? Do you believe in having a positive impact on other people's lives? Are you a team player, quick-thinker, and ready to be a part of an organization that supports your growth? WHAT WE'RE ABOUT We believe care goes beyond a medical chart. With kindness and integrity as our guide, we strive for excellence in every interaction. Requirements: You care. Director of Staff Development Perks: Generous Bonuses Growth Opportunities - DOUBLE your salary Health Benefits POSITION SUMMARY Provides necessary orientation, educational and learning opportunities within a supportive environment that will assist personnel in gaining knowledge, skills and attitudes necessary to perform assigned duties safely and effectively. Monitors the activities of nursing personnel to ensure quality care that complies with state, federal and corporate standards. Directs the infection prevention and control program and its activities in accordance with current federal, state, and local standards, guidelines, and regulations that govern such programs, and as may be directed by the Director of Nursing, to ensure that an effective infection prevention and control program is maintained at all times. DUTIES AND RESPONSIBILITIES Demonstrates commitment to company's mission, values and standards of ethical behavior. Models a positive and professional image that emulates the organization's mission and encourages a spirit of cooperation with co-workers. Provides assistance to co-workers and promotes teamwork by sharing information useful to achieving desired results. Ensures that all residents are treated fairly, with kindness, dignity, and respect, and their rights are protected at all times. Respects and upholds all residents' personal and property rights whenever carrying out duties, including knocking before entering a resident's room. Complies with all company and departmental policies and procedures. Utilizes regulations, policies, procedures and job descriptions to define, plan, implement and evaluate learning opportunities. Assesses learning needs of personnel in order to meet the needs of the resident, organization and employee KNOWLEDGE, SKILLS, ABILITIES & QUALIFICATIONS 1-3 years' experience providing direct care to multiple patients/residents preferred; previous experience as Charge Nurse in Skilled Nursing environment desirable; supervisory experience preferred Nursing degree from accredited college or graduation from approved RN or LVN program required Current unencumbered license to practice as an RN or LVN in California Current, valid CPR certification BENEFITS Medical insurance with Rx benefits Dental insurance Vision care Paid vacation #J-18808-Ljbffr

Position: Clinical Social Worker Increased Salaries are Just the Beginning… The past few years have seen dramatic shifts in the health care landscape. California Correctional Health Care Services (CCHCS) is poised to meet the evolving clinical care demands of our patient population while responding to the day-to-day needs of our dedicated providers. $108,576–$123,132 (Licensed) $101,100–$114,456 (Pre-Licensed) Clinical Social Workers providing in-person care in an inpatient unit will receive: $124,862–$141,601 (Licensed) $116,265–$131,624 (Pre-Licensed) Recruitment and Retention Bonus Clinical Social Workers newly hired with CDCR/CCHCS and providing in-person care at a facility 50% or more of their time will receive a 1% Recruitment and Retention bonus for the first 7 years of their employment, increasing by 1% year over year, maxing at a 7% bonus by year 7. Clinical Social Workers newly hired with the State of CA are also eligible to receive a recruitment and retention bonus of up to $30,000 within the first 12 months of service. Referral Bonus All CDCR/CCHCS employees that refer a mental health clinician who is successfully hired by CCHCS may be eligible to receive a referral bonus of $5,000 per appointed referral. Additional Benefits of Practicing with CDCR/CCHCS But increased salaries are just the beginning – our clinical social workers also receive comprehensive State of California benefits, including: Comprehensive Medical, Dental, and Vision Coverage: Ensure your and your family's health with full coverage. Work-life Balance with Flexible Schedules: Achieve balance with the option of 4-day workweeks at many locations. Robust 401(k) and 457(b) Retirement Plans: Secure your retirement with our extensive plans, allowing tax deferral up to State of CA Retirement that Vests in Five Years: Plan for a secure future with our fast-vesting pension benefits (more at www.CalPERS.ca.gov). CE Annual Stipend of $500/year, Licensed Renewal Reimbursement, and Bi-Annual Allocation of 36 hours for CE: Invest in your professional development with our Continuing Education benefits. Rewarding Work with an Underserved/Underprivileged Population: Positively impact lives while growing professionally. Generous Paid Time Off and Holiday Schedule: Enjoy ample time away from work for relaxation and personal pursuits. Collaborative, Multidisciplinary Teams: Join a supportive environment fostering professional growth and collaboration. Safety and Security: Our professional, well-trained Correctional Officers ensure a safe working environment. Potential NHSC Loan Repayment: Qualify for loan repayment, depending on your assignment location. Dedicated Assistance with Visa Sponsorship & Relocation Assistance: We're here to help with your California transition, whether you’re moving here for the first time of moving across state. Take the first step and submit your CV to MedCareers@cdcr.ca.gov or apply directly to this posting today! EOE Department Information The California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) are committed to building an inclusive and culturally diverse workplace. We are determined to attract and hire more candidates from diverse communities and empower all employees from a variety of backgrounds, perspectives, and personal experiences. We are proud to foster inclusion and drive collaborative efforts to increase representation at all levels of the Department. CDCR/CCHCS values all team members. We work cooperatively to provide the highest level of health care possible to a diverse correctional population, which includes medical, dental, nursing, mental health, and pharmacy. We encourage creativity and ingenuity while treating others fairly, honestly, and with respect, all of which are critical to the success of the CDCR/CCHCS mission. CDCR and CCHCS are proud to partner on the California Model which will transform the correctional landscape for our employees and the incarcerated. The California Model is a systemwide change that leverages national and international best practices to address longstanding challenges related to incarceration and institution working conditions, creating a safe, professional, and satisfying workplace for staff as well as rehabilitation for the incarcerated. Additionally, the California Model improves success of the decarcerated through robust re-entry efforts back into to the community. Department Website: https://cchcs.ca.gov/careers

Thriveworks is currently seeking Licensed Clinicians to provide a mix of telehealth and face-to-face sessions in La Habra, CA. Thriveworks is a clinician-founded national private practice group with locations in 48 states. Our mission is to help people live happy, successful lives, and we believe that client accessibility, integrity, and quality care are what is most important. We put a lot of emphasis on the thought that—in order for our clinical team to be accessible to clients—we must fully support our clinicians by allowing them to do what they are trained to do. We operate under the idea that we are most successful by focusing on one job and being great at that job. Qualifications: All eligible candidates must have one of the following independent licenses in California: LPCC or LMFT or LCSW Licensed Clinical Psychologists (PhD or PsyD) Clinicians need to be licensed and living in the state in which they will be practicing Compensation: Up to $125,400 depending on licensure, sessions, and bonus opportunities What We Need: Individuals willing to see a minimum of 25 sessions per week A true partnership Behavioral Health Generalists - open to seeing couples and/or children (we provide support!) Candidates that may be looking to grow into leadership roles/supervisors Self guided determination to complete your notes inside of 24 hours Strong character matters - integrity, honesty, adaptability and quality of care to name a few Individuals who enjoy being a part of team and working together to professionally develop What We Give: We are dedicated to taking great care of our employees and empowering them to succeed. This enables them to focus on providing excellent care to our clients. We offer the following benefits: Guaranteed pay Paid orientation PTO Annual pay increases Additional bonus opportunities Flexibility with your schedule - we’re open 7am-10pm (seven days a week) No-Show Protection Full clinical caseload typically established within the first 90 days (after credentialing) Group health and dental, disability, life, and liability insurance options A W2 employment model with access to a 401k program with a 3% employer match CEU Reimbursement Access to “motivated” patient population Opportunities for paid clinical supervisory roles Monthly in-house professional development No required call We credential you! Support team for scheduling and client service with extended hours Customized Marketing Autonomy, but with access to case consultation groups Amazing team culture and clinical support Malpractice Coverage Career advancement opportunities Brand pride Who we are - about Thriveworks: Thriveworks is a clinician-owned National outpatient mental health private practice group We are currently operating in 48 states and are continuing to expand Corporate headquartered in Fredericksburg, VA A career at Thriveworks isn’t just about finding a job that pays the bills. It’s about helping others, joining a community, and learning to thrive both personally and professionally. We believe that the success of our employees is just as important as the success of our organization — in fact, they go hand in hand. So, what do you say? Are you interested in joining our team? Apply today. ​ #LI-Hybrid #LI-MS1 Interested in joining Team Thriveworks? We're thrilled to meet you! With Job scams becoming more and more frequent, here's how to know you're speaking with a real member of our team: Our recruiters and other team members will only email you from thriveworks@myworkday.com or an @thriveworks.com email address. Our interviews will take place over Google Meet (not Microsoft Teams or Zoom) We will never ask you to purchase or send us equipment. If you see a scam related to Thriveworks, please report to infosec@thriveworks.com. You can contact employment@thriveworks.com with any questions or concerns. Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team. By clicking Apply, you acknowledge that Thriveworks may contact you regarding your application.

Thriveworks is currently seeking Licensed Clinicians to provide a mix of telehealth and face-to-face sessions in La Habra, CA. Thriveworks is a clinician-founded national private practice group with locations in 48 states. Our mission is to help people live happy, successful lives, and we believe that client accessibility, integrity, and quality care are what is most important. We put a lot of emphasis on the thought that—in order for our clinical team to be accessible to clients—we must fully support our clinicians by allowing them to do what they are trained to do. We operate under the idea that we are most successful by focusing on one job and being great at that job. Qualifications: All eligible candidates must have one of the following independent licenses in California: LPCC or LMFT or LCSW Licensed Clinical Psychologists (PhD or PsyD) Clinicians need to be licensed and living in the state in which they will be practicing Compensation: Up to $125,400 depending on licensure, sessions, and bonus opportunities What We Need: Individuals willing to see a minimum of 25 sessions per week A true partnership Behavioral Health Generalists - open to seeing couples and/or children (we provide support!) Candidates that may be looking to grow into leadership roles/supervisors Self guided determination to complete your notes inside of 24 hours Strong character matters - integrity, honesty, adaptability and quality of care to name a few Individuals who enjoy being a part of team and working together to professionally develop What We Give: We are dedicated to taking great care of our employees and empowering them to succeed. This enables them to focus on providing excellent care to our clients. We offer the following benefits: Guaranteed pay Paid orientation PTO Annual pay increases Additional bonus opportunities Flexibility with your schedule - we’re open 7am-10pm (seven days a week) No-Show Protection Full clinical caseload typically established within the first 90 days (after credentialing) Group health and dental, disability, life, and liability insurance options A W2 employment model with access to a 401k program with a 3% employer match CEU Reimbursement Access to “motivated” patient population Opportunities for paid clinical supervisory roles Monthly in-house professional development No required call We credential you! Support team for scheduling and client service with extended hours Customized Marketing Autonomy, but with access to case consultation groups Amazing team culture and clinical support Malpractice Coverage Career advancement opportunities Brand pride Who we are - about Thriveworks: Thriveworks is a clinician-owned National outpatient mental health private practice group We are currently operating in 48 states and are continuing to expand Corporate headquartered in Fredericksburg, VA A career at Thriveworks isn’t just about finding a job that pays the bills. It’s about helping others, joining a community, and learning to thrive both personally and professionally. We believe that the success of our employees is just as important as the success of our organization — in fact, they go hand in hand. So, what do you say? Are you interested in joining our team? Apply today. ​ #LI-Hybrid #LI-MS1 Interested in joining Team Thriveworks? We're thrilled to meet you! With Job scams becoming more and more frequent, here's how to know you're speaking with a real member of our team: Our recruiters and other team members will only email you from thriveworks@myworkday.com or an @thriveworks.com email address. Our interviews will take place over Google Meet (not Microsoft Teams or Zoom) We will never ask you to purchase or send us equipment. If you see a scam related to Thriveworks, please report to infosec@thriveworks.com. You can contact employment@thriveworks.com with any questions or concerns. Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team. By clicking Apply, you acknowledge that Thriveworks may contact you regarding your application.

Thriveworks is currently seeking Licensed Clinicians to provide a mix of telehealth and face-to-face sessions in Irvine, CA. Thriveworks is a clinician-founded national private practice group with locations in 48 states. Our mission is to help people live happy, successful lives, and we believe that client accessibility, integrity, and quality care are what is most important. We put a lot of emphasis on the thought that—in order for our clinical team to be accessible to clients—we must fully support our clinicians by allowing them to do what they are trained to do. We operate under the idea that we are most successful by focusing on one job and being great at that job. Qualifications: All eligible candidates must have one of the following independent licenses in California: LPCC or LMFT or LCSW Licensed Clinical Psychologists (PhD or PsyD) Clinicians need to be licensed and living in the state in which they will be practicing Compensation: Up to $125,400 depending on licensure, sessions, and bonus opportunities What We Need: Individuals willing to see a minimum of 25 sessions per week A true partnership Behavioral Health Generalists - open to seeing couples and/or children (we provide support!) Candidates that may be looking to grow into leadership roles/supervisors Self guided determination to complete your notes inside of 24 hours Strong character matters - integrity, honesty, adaptability and quality of care to name a few Individuals who enjoy being a part of team and working together to professionally develop What We Give: We are dedicated to taking great care of our employees and empowering them to succeed. This enables them to focus on providing excellent care to our clients. We offer the following benefits: Guaranteed pay Paid orientation PTO Annual pay increases Additional bonus opportunities Flexibility with your schedule - we’re open 7am-10pm (seven days a week) No-Show Protection Full clinical caseload typically established within the first 90 days (after credentialing) Group health and dental, disability, life, and liability insurance options A W2 employment model with access to a 401k program with a 3% employer match CEU Reimbursement Access to “motivated” patient population Opportunities for paid clinical supervisory roles Monthly in-house professional development No required call We credential you! Support team for scheduling and client service with extended hours Customized Marketing Autonomy, but with access to case consultation groups Amazing team culture and clinical support Malpractice Coverage Career advancement opportunities Brand pride Who we are - about Thriveworks: Thriveworks is a clinician-owned National outpatient mental health private practice group We are currently operating in 48 states and are continuing to expand Corporate headquartered in Fredericksburg, VA A career at Thriveworks isn’t just about finding a job that pays the bills. It’s about helping others, joining a community, and learning to thrive both personally and professionally. We believe that the success of our employees is just as important as the success of our organization — in fact, they go hand in hand. So, what do you say? Are you interested in joining our team? Apply today. ​ #LI-Hybrid #LI-MS1 Interested in joining Team Thriveworks? We're thrilled to meet you! With Job scams becoming more and more frequent, here's how to know you're speaking with a real member of our team: Our recruiters and other team members will only email you from thriveworks@myworkday.com or an @thriveworks.com email address. Our interviews will take place over Google Meet (not Microsoft Teams or Zoom) We will never ask you to purchase or send us equipment. If you see a scam related to Thriveworks, please report to infosec@thriveworks.com. You can contact employment@thriveworks.com with any questions or concerns. Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team. By clicking Apply, you acknowledge that Thriveworks may contact you regarding your application.

Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance. Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members admitted to inpatient facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria Work with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed Manager Recognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards Your Knowledge and Experience Bachelor of Science or advanced degree preferred Current unrestricted CA license (LCSW, LMFT, LPCC, Licensed Psychologist, or Registered Nurse (RN) with Behavioral Health experience) Requires at least five (5) years of prior experience in healthcare related field Three (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferred Strong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelines Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases Excellent analytical, communication skills, written skills, time management, and organizational skills Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative Ability to identify problems and works towards problem resolution independently, seeking guidance as needed

Your Role Reporting to the Manager, Care Management- Behavioral Health, the Licensed Clinician, Senior (ABA Case Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. This role is ideal for professionals with a background and experience in Applied Behavioral Analysis and passion for ensuring access to high quality behavioral health services. The ABA Case Manager will coordinate care and services for families, supporting members and families through their care. The ABA Case Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, and with any general behavioral or mental health referrals. The position requires an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages. Your Work In this role, you will: Collaborate with other Case Managers and Utilization Management to complete member assessments related to social and resource needs to support member access to services Collaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needs Collaborate with providers to support members’ treatment plan and care needs Recognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Assess members health behaviors, cultural influences and clients belief/value system and evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers Efficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness as well as members seeking and utilizing ABA services. Maintains an active workload in accordance with National Care Manager performance standards. Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria. Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases. Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independently As a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.) Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.) Your Knowledge and Experience Current unrestricted CA License (LCSW, LMFT, LPCC, Registered Nurse (RN), or PsyD by the Board of Behavioral Health Sciences required Requires at least 5 years of prior relevant experience including 3 years of experience in behavioral health or ABA, case management. Advanced degree commensurate with field is preferred BCBA Preferred Experience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housing Considerable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatment Previous health plan or insurance experience preferred. Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint

Work Schedule M-Th 10:30-7:00 F 9:30-6:00 Your Role The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. documentation. Your Work In this role, you will: Coordinates care for Lower Level of Care such as Residential Treatment, Partial Hospitalization Program, Intensive Outpatient Program, other outpatient services, and community programs as appropriate. Research and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes Initiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settings Applies detailed knowledge of FEP PPO and Blue Shield of California's (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral health. Must be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentation. Your Knowledge and Experience Requires a current CA RN License Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements Requires at least 5 years of prior experience in nursing, healthcare or related field Bachelor of Science in Nursing or advanced degree preferred. Requires relevant behavioral health experience. Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources. Able to operate PC-based software programs including proficiency in Word and Excel. Strong clinical documentation skills, independent problem identification and resolution skills. Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills. Competent understanding of NCQA and federal regulatory requirements. Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable. Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care. Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making.