Department(s): Long Term Care (LTC)
Reports to: Manager Long Term Support Services
FLSA status: Non-Exempt
Salary Grade: C - $43,281 - $61,798

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on ** Monday, December 18, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. **

About CalOptima Health

Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you’re looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!

About the Position

The Medical Authorization Assistant will provide office and case management support services by serving as a contact between members, physicians, nursing home facilities, community-based organizations, providers and CalOptima Health staff. The incumbent will complete initial intake of information, assist with authorization functions and gather information. The incumbent will perform under the direction of the licensed Medical Case Managers, Social Workers, Program Mangers and department managers. The incumbent will perform medical administrative and/or routine tasks specific to the assigned program and may also perform office support functions. The incumbent will provide effective and efficient communication with the utmost courtesy in every interaction with our CalOptima Health members, employees and other customers.

Duties & Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Receives cases via mail, fax, phone or electronically and enters data for new case information into the medical management systems.
• Conducts individual interviews with CalOptima Health members and/or providers to obtain intake information and gather data.
• Works with the Medical Case Manager to authorize requested services according to department guidelines and verifies eligibility through the state systems.
• Contacts the health networks and/or CalOptima Health’s Customer Service department regarding health network enrollments, changes in address and primary care provider.
• Assists in gathering medical records, obtaining appropriate coding for diagnosis and procedures and follows up on phone calls.
• Documents all contacts and case information in the appropriate medical management system using the standard charting format.
• Performs data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed.
• Generates monthly and other required reports from the databases as requested by the Medical Case Manager and/or health networks.
• Sends letters to providers and members.
• Answers calls and provides customer service to providers and members, provides care coordination and refers the callers to the correct department.
• Completes other projects and duties as assigned.

Experience & Education:

• High School diploma or equivalent required.
• 2 years of experience in a health care or managed care setting required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Certified Medical Assistant (CMA) certification.
• Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.
• Previous medical billing or coding experience.
• Utilization management experience.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as and work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

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CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

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If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

Required Skills

Required Experience

Qualifications:

• Education and/or a chosen career path in biology, zoology, or other natural resource-related discipline.
• Applicants should possess strong organizational skills, data collection skills, strategic thinking abilities, be flexible and resourceful, be able to work well with others in a professional setting and be self-motivated and able to work independently or as part of a team with limited supervision.
• Flexibility and willingness to learn.
• Experience with ArcGIS Pro.
• Applicants must pass a criminal history background check and should possess a valid driver’s license with a clean driving record.
• Upon employment, complete DOI’s Information Management and Technology (IMT) Awareness Training.

Physical Requirements:

• Ability to work in extreme temperatures, remote working conditions, uneven terrain, hiking off-trail and along unmarked paths, as well as driving on primitive roads.
• To successfully perform essential functions, the individual is required to sit, stand, walk, speak, hear, etc.
• Reasonable accommodations may be made for qualified individuals with disabilities to perform the essential functions.

Participant Essential Eligibility Requirements:

Participation and Expedition Behavior:

• Work effectively as a member of a team despite potentially stressful and difficult conditions. This may require problem solving on an interpersonal or group level as well as a willingness to accept differences.
• Contribute to a safe learning environment, no harassment of others for any reason.
• Willingness and ability to complete all aspects of the program including conservation projects, education, training, and national service. Members must commit to participating in all agency/team activities.
• Effectively communicate ideas and concerns as they arise directly to supervisors, colleagues, and organization staff.
• Appropriately represent Arizona Conservation Corps and the Bureau of Reclamation to the public and partners at all times.

Safety and Judgment:

• Effectively perceive, understand, and follow direction by others so that you will be able to successfully execute techniques to manage hazards.
• Stay alert and focused for several hours at a time.
• Respond appropriately to stress or crisis.
• If taking prescriptions medications, participants must be able to maintain proper dosage by self-medicating without assistance from others.

Substance Free:

• In accordance with a drug free workplace, alcohol and drugs are prohibited while participating in AmeriCorps and program activities and while on organization property.

Background Check:

A Department of Interior (DOI) background clearance must be completed before the selected candidate may report to duty. The BOR will provide instructions for completing the clearance after an intern has been selected and will notify them when they have been cleared to start the internship. This process will determine the internship’s exact start date.

To Apply:

Please submit an your resume and cover letter along with the online application using the APPLY NOW link below. If you have questions, contact AZCC’s Individual Placement Coordinator, Preston Sands, at psands@conservationlegacy.org.

For more information about Arizona Conservation Corps, please visit www.azcorps.org. Arizona Conservation Corps is a program of Conservation Legacy.