Find Jobs (Post Jobs)
- Accounting / Finance Jobs (14697)
- Architect / Engineering Jobs (4029)
- Business and Management Jobs (2727)
- Environmental Jobs (14686)
- Government Jobs (190087)
- Health Care Jobs (4771)
- Hospitality Jobs (21581)
- Janitorial Jobs (2457)
- Legal Jobs (12150)
- Nanny Jobs / Babysitting (6)
- Office Jobs (89255)
- Other Jobs (853)
- Retail / Wholesale Jobs (10970)
- Sales Jobs (10970)
- Science (17385)
- Security (3621)
- Skilled Trades / Crafts (4029)
- Transportation Jobs (195)
- Travel / Transportation (501)
Jobs By State
- Alabama (205)
- Alaska (178)
- Arizona (1509)
- Arkansas (118)
- California (73044)
- Colorado (491)
- Connecticut (43)
- Delaware (23)
- Florida (413)
- Georgia (381)
- Hawaii (194)
- Idaho (2801)
- Illinois (222)
- Indiana (168)
- Iowa (94)
- Kansas (148)
- Kentucky (228)
- Louisiana (196)
- Maine (57)
- Maryland (551)
- Massachusetts (182)
- Michigan (232)
- Minnesota (153)
- Mississippi (160)
- Missouri (280)
- Montana (163)
- Nebraska (77)
- Nevada (235)
- New Hampshire (35)
- New Jersey (132)
- New Mexico (329)
- New York (329)
- North Carolina (313)
- North Dakota (91)
- Ohio (236)
- Oklahoma (201)
- Oregon (150)
- Pennsylvania (285)
- Rhode Island (19)
- South Carolina (175)
- South Dakota (128)
- Tennessee (142)
- Texas (804)
- Utah (5452)
- Vermont (43)
- Virginia (756)
- Washington (32241)
- West Virginia (147)
- Wisconsin (118)
- Wyoming (147)
100,000's of Government Jobs
Search Government Jobs
MEDICAL PROGRAM MANAGER-INTEGRATED TELECOMMUTING OPTION! DUALS PROGRAM (CA - HUNTI
Job Field: Environmental Jobs
Location: San Bernardino, CA
Salary: $Not stated
Location: San Bernardino, CA
Salary: $Not stated
JOB SUMMARY:
</tr>
<tr><td valign="top" width="450"><b>Title: Medical Program Manager-INTEGRATED TELECOMMUTING OPTION! Duals Program (CA - Huntington Beach, San Bernardino, or San Diego)Location: United States-California-San BernardinoOther Locations: United States-California-Huntington Beach, United States-California-San DiegoHealth Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.For more information on Health Net, Inc., please visit the company's website atwww.healthnet.com. JOB SUMMARY: MEDICAL PROGRAM MANAGER - Integrated Telecommuting Option! RN RequiredThe Medical Program Manager monitors and evaluates PMG/IPA (Participating Medical Group/Independent Practice Association) utilization management, quality improvement, and educational programs to ensure they meet Health Net's contractual and regulatory requirements. This position also acts as a consultant to medical groups to assist them in the design and enhancement of their UM/QI (Utilization Management/Quality Improvement) programs.ESSENTIAL DUTIES AND RESPONSIBILITIES:* Performs on-site evaluations of PPG/IPA (Participating Physician Group/Independent Practice Association) UM/QI programs to monitor quality and appropriateness of care and utilization management and summarizes results of findings. Reviews utilization and quality data, prepares status reports of PPG/IPAs, which includes recommendations to improve performance, resolve problems, and/or correct aberrances.* Consults with, assists, and advises the Regional Medical Director and regional associates in areas related to: needs identification, development and implementation of utilization management, medical review, quality improvement and educational programs.* Implements, participates in, conducts, and evaluates medical and educational processes, care delivery sites, programs and procedures for PMG/IPA physicians and staff, other health care providers, Health Net coordinators, Health Net staff, employer/employee groups, and other affected parties. Assesses knowledge of and compliance with HMO (Health Maintenance Organization) regulations and Health Net standards.* Implements, conducts, and evaluates performance measurement and monitoring of Health Net and PMG/IPA utilization and quality programs and medical review to ensure quality and appropriateness of service and compliance with contractual agreements, medical standards, medical policies, and compliance with government regulations.* Participates in PMG/IPA UM Committee/QI Committee and evaluates and assists in the areas related to Health Net. Reports results of Health Net's quality improvement activity, utilization management, and education.* Performs other duties as assigned.REQUIREMENTS:Education:Graduate of an accredited nursing program required; Bachelor's degree in nursing or health care field preferred.Certification/License:* Active, valid & unrestricted State of California Registered Nurse license required.* Valid & unrestricted driver's license for the State of California required.Experience
</tr>
<tr><td valign="top" width="450"><b>Title: Medical Program Manager-INTEGRATED TELECOMMUTING OPTION! Duals Program (CA - Huntington Beach, San Bernardino, or San Diego)Location: United States-California-San BernardinoOther Locations: United States-California-Huntington Beach, United States-California-San DiegoHealth Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.For more information on Health Net, Inc., please visit the company's website atwww.healthnet.com. JOB SUMMARY: MEDICAL PROGRAM MANAGER - Integrated Telecommuting Option! RN RequiredThe Medical Program Manager monitors and evaluates PMG/IPA (Participating Medical Group/Independent Practice Association) utilization management, quality improvement, and educational programs to ensure they meet Health Net's contractual and regulatory requirements. This position also acts as a consultant to medical groups to assist them in the design and enhancement of their UM/QI (Utilization Management/Quality Improvement) programs.ESSENTIAL DUTIES AND RESPONSIBILITIES:* Performs on-site evaluations of PPG/IPA (Participating Physician Group/Independent Practice Association) UM/QI programs to monitor quality and appropriateness of care and utilization management and summarizes results of findings. Reviews utilization and quality data, prepares status reports of PPG/IPAs, which includes recommendations to improve performance, resolve problems, and/or correct aberrances.* Consults with, assists, and advises the Regional Medical Director and regional associates in areas related to: needs identification, development and implementation of utilization management, medical review, quality improvement and educational programs.* Implements, participates in, conducts, and evaluates medical and educational processes, care delivery sites, programs and procedures for PMG/IPA physicians and staff, other health care providers, Health Net coordinators, Health Net staff, employer/employee groups, and other affected parties. Assesses knowledge of and compliance with HMO (Health Maintenance Organization) regulations and Health Net standards.* Implements, conducts, and evaluates performance measurement and monitoring of Health Net and PMG/IPA utilization and quality programs and medical review to ensure quality and appropriateness of service and compliance with contractual agreements, medical standards, medical policies, and compliance with government regulations.* Participates in PMG/IPA UM Committee/QI Committee and evaluates and assists in the areas related to Health Net. Reports results of Health Net's quality improvement activity, utilization management, and education.* Performs other duties as assigned.REQUIREMENTS:Education:Graduate of an accredited nursing program required; Bachelor's degree in nursing or health care field preferred.Certification/License:* Active, valid & unrestricted State of California Registered Nurse license required.* Valid & unrestricted driver's license for the State of California required.Experience
KEY REQUIREMENTS:
Not stated
Tips