Call Center Application Assistor – Bilingual English-Spanish
Interview and pre-qualify potential members and provide application assistance for Medi-Cal, Healthy Families or Healthy Kids programs via outbound and inbound telephone calls or in person. Perform other member outreach activities designed to promote member satisfaction and member retention. Respond to member questions, concerns, and requests competently and in a timely and respectful manner. Cultivate positive and productive relationships with members, providers, community-based organizations, and SCFHP staff. Utilize database to document and code all Call Center activities regarding all of the above and maintain accurate, easily retrievable, member contact files. REQ: Fully bilingual in Spanish; successfully complete Plan Application Assistance Certification training; express oneself concisely and effectively in a professional manner; able to work non-standard workweek schedule (see Complete Job Description for hours).

Job Code: CCAA-0608
Hours: Full Time
Wage Range: $19.23 - $28.84 Per Hour
Complete Job Description

Eligibility Coordinator—Bilingual Spanish-English
Ensure proper processing of enrollment eligibility, monthly invoicing, premium collection and account reconciliation for the Children’s Health Initiative Program (CHIP). Review and evaluate CHIP applications for eligibility according to Plan guidelines; log all applications to reflect status, delays or denial. Provide systems input; update enrollee information. Prepare monthly reports to reflect enrollment gains, losses and denials. Prepare correspondence to address and resolve enrollment problems; identify trends that indicate problem areas to address. Req: 3+ years’ related accounts receivable experience, preferably in insurance or health care/HMO entity; Word, Excel, and databases; bilingual English-Spanish.

Job Code: EC-SP0608
Hours: Full Time
Wage Range: $14.90 - $21.63 per hour
Complete Job Description

Medicare Sales & Service Representative- Bilingual
Market Healthy Generations insurance (HG) to seniors and the disabled to obtain targeted enrollments. Develop leads and other effective sales resources, such as 1-on-1 and group sales presentations to reach goals. Provide seniors and the disabled with member information about SCFHP at cultural events, fairs, and community events. Conduct targeted outreach to community-based organizations, provider groups, prospects, and members to stimulate interest that leads to enrollments. Once enrolled, inform members about Plan benefits and services and educate members on how to access services. Work directly with members and member representatives to resolve questions, concerns or issues. Initiate outbound calls to HG members and member representatives. Participate in management of grievances according to CMS Guidelines. Req: 2+ years’ sales and service experience in insurance/health care-related field; CA Life License or be able to pass examination within 1 month of employment; bilingual English-Mandarin; accomplished in sales and services techniques; 1 year experience with issues facing the Medicare population and diverse social and ethnic groups; computer skills; able and willing to work extended hours and weekends.

Job Code: MSSR—M0608
Hours: Full Time
Wage Range: Depends Upon Experience
Complete Job Description

Member Services Rep—Bilingual
Support the activities of the Member Services Department and function as the member advocate and representative. Work directly with members and providers of care/service on the phone to identify and resolve member and staff questions, concerns, conflicts or issues that involve the services and benefits within SCFHP. Ensure that member relations and retention are appropriately maintained. Inform members about health plan options and benefits, and educate members on proper use of the Plan. REQ: Fully bilingual in English and Spanish; willing to serve the Spanish-speaking community, as well as the Medi-Cal population in general; BA/BS with 2 yrs. member/customer service experience in managed care and/or health insurance OR 4+ years equivalent experience in health care is preferred; type 45 wpm.

Job Code: MSR-SP0608
Hours: Full Time
Wage Range: $16.10 - $23.07 per hour
Complete Job Description

MTM Pharmacist
Develop and implement a Medication Therapy Management program for our Medicare and Agnews product, and support Clinical Pharmacist in planning, delivery and operation of pharmacy program for Health Plan Members and Health Plan overall. Review escalated prior authorizations and perform necessary research to determine medical necessity and appropriate coverage. Support pharmacy management projects to meet goals and objectives. Participate in research, preparation and presentation of Pharmaceutical & Therapeutic material. Resolve routine operational issues and maintain on-going communications with pharmacies and physician offices. Maintain updates and compile information used in Pharmacy interventions and implementations and perform periodic spot audits to validate information. Req: Registered Pharmacist in CA; 5+ years in clinical pharmacy; intermediate-advanced skill level to: gather/analyze data; organize/write reports, interpret/apply applicable rules and regulations, communicate effectively, handle multiple projects simultaneously, consistently meet deadlines; self-directed; work collaboratively.

Job Code: MTMP-0508
Hours: Full Time
Wage Range: Depends Upon Experience
Complete Job Description

Utilization Management Case Manager, RN - 2 Openings
Perform day-to-day medical case management for inpatient and outpatient activities, utilizing approved policies, standards, and clinical criteria. Analyze and evaluate medical records and other health data to meet medical necessity determination turn-around times and provide review outcomes to member and provider as per appropriate notification standards. Assist in the development of disease management strategies to support persons with disabilities and chronic conditions to improve healthcare outcomes. Contribute to the development and maintenance of the case management policies for all populations, identifying new policies and procedures that are required. Prepare and maintain internal files and/or logs for members served by these case management programs and methods of tracking activities. REQ: Current CA RN license; Minimum 3 years in acute care; 1 year in Managed Care, UM, or Case Management; MS Office and Windows-based databases.

Job Code: UMCM-0508
Hours: Full Time
Wage Range: Depends Upon Experience
Complete Job Description