Overview
Program Assistant/Potential Quality Issues Jobs in Orange – California – USA at CalOptima
Program Assistant (Potential Quality Issues)
Job Description
Department(s):Quality Improvement
Reports to:Manager Quality Improvement
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 onTuesday, February 20, 2024 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 Cal Optima Health
Are you looking for a career that changes lives? As the single largest health plan in Orange County, Cal Optima 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,recognitionand opportunities to grow.
If you’re looking for a rewarding career supporting a meaningful mission, along with generous benefits andrecognition, consider joining us at Cal Optima Health!
About the Position
The Program Assistant (Potential Quality Issues) will provide assistance with specialized tasks relevant to Potential Quality Issues (PQI) in support of the Quality Improvement (QI) Nurses and Medical Directors.
Duties & Responsibilities:
Participates in amission-drivenculture 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 and processes clinical PQI files for QI Nurse Specialist in the electronic system.
Requests medical records or clinical responses from health networks, physician medical groups and providers.
Obtains and files copies of medical records in the electronic system.
Documents and logs PQI information in the electronic system.
Collects data, identifies pertinent information and prepares files for review by the QI Nurse Specialist and Medical Director.
Generates and mails appropriate written correspondence to providers, members and health networks.
Contacts members, health networks or providers to get additional information or coordinate care.
Prepares PQI files for the Credentialing and Peer Review Committee (CPRC) and sends files electronically to the appropriate Medical Director.
Prepares and submits files for external review and retrieves files once the review is completed.
Assists withcommunicationstatus of activities with the nurses, Medical Directors,leadership, Cal Optima Health departments and health networks.
Represents PQI on projects or acts as a liaison within or outside Cal Optima Health.
Completes other projects and duties as assigned.
Experience &Education:
High School diploma or equivalent required.
1 year of experience in working with provider offices or hospitals requesting medical records in a managed care-health plan or a medical group required.
1 year of experience in administrative support required.
An equivalent combination ofeducationand experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifica…
Title: Program Assistant/Potential Quality Issues
Company: CalOptima
Location: Orange – California – USA
Category: Healthcare, Administrative/Clerical
