CLAIMS DEPARTMENT:

Job Title:  Claims Examiner

Job responsibilities include the following:

Responsible for processing routine claims to determine type and amount of benefit payable.  Performs limited duties, subject to review and approval, for the processing of such claims assigned, consistent with applicable policies, procedures and department guidelines.

The ideal candidate will possess:

High school diploma or GED; Minimum 2-3 year claims experience, preferably in an IPA or HMO or CalOptima setting; Must be extremely detail oriented with strong interpersonal skills; Knowledge of EZ-CAP system required.  Other Requirements:  Proficiency with Data entry; Ability to multi-task; Excellent organizational skills; Self-motivation

CLINICAL SERVICES DEPARTMENT:

Job Title: Vice President, Clinical Services

Job responsibilities include the following:

Responsible for providing overall direction, design, development, implementation, and monitoring of the Clinical Services departments.  This includes Referral Management, Outpatient Case Management, Inpatient Case Management, Hospitalist Services, and Quality Improvement.  Works closely and in cooperation with the client(s) Chief Medical Officer and Medical Director(s) to ensure a successful implementation of the client’s vision, medical policies and procedures.

 SUPERVISORY RESPONSIBILITIES:

Manages the Director, Inpatient Services, Director, Outpatient Services, and Manager, Quality Improvement.  Responsible for the overall direction, coordination and evaluation of these units.

The ideal candidate will possess:

Bachelor’s degree (B.A.) from four-year accredited school of nursing.  Minimum 5 years in a management role with a managed care organization.  Masters in Nursing, Business or Health Care management preferred. Thorough knowledge of HMO, IPA, and managed care business concepts and principles.  Excellent organizational skills.  Able to manage stressful situations with poise and professionalism.  A sense of humor.

Job Title: Director, Inpatient Services

Job responsibilities include the following:

Responsible for providing direction, design, development, implementation, and monitoring of the Inpatient Services departments.  This includes Inpatient Case Management, and Hospitalist Services.  Works closely and in cooperation with the client(s) Chief Medical Officer and Medical Director(s) to ensure a successful implementation of the client’s vision, medical policies and procedures.

SUPERVISORY RESPONSIBILITIES:

Manages subordinate employees in the U.M. Department. Is responsible for the overall direction, coordination, and evaluation of these employees.

The ideal candidate will possess:

Bachelor's degree (B.A.) from four-year college or university; or three to five years related experience and/or training; or equivalent combination of education and experience.  Current California Nursing License.  Thorough knowledge of HMO, IPA, and managed care business concepts and principles.  Excellent organizational skills.  Able to manage stressful situations with poise and professionalism.  A sense of humor.

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Job Title: Director, Outpatient Services

Job responsibilities include the following:

Responsible for providing direction, design, development, implementation, and monitoring of the Outpatient Services departments.  This includes the Referral Management and Outpatient Case Management departments.  Works closely and in cooperation with the client(s) Chief Medical Officer and Medical Director(s) to ensure a successful implementation of the client’s vision, medical policies and procedures.

SUPERVISORY RESPONSIBILITIES:

Manages the Manager, Referral Management and the Manager, Outpatient Case Management.  Responsible for the overall direction, coordination and evaluation of these units.

The ideal candidate will possess:

Bachelor’s degree (B.A.) from four-year accredited school of nursing.  Minimum 3 years in a management role with a managed care organization.  Masters in Nursing, Business or Health Care management preferred.  Thorough knowledge of HMO, IPA, and managed care business concepts and principles.  Excellent organizational skills.  Able to manage stressful situations with poise and professionalism.  A sense of humor.

Job Title:  Manager, Hospitalist Services

Job responsibilities include the following:

Responsible for is responsible for the administration of the Monarch Healthcare Hospitalist program serving Orange County, California.  The primary focus is working with the Medical Director, Hospitalist Services, to administer the employed Hospitalist program, with secondary responsibility for coordinating the contracted provider network serving the remaining portions of the county.  The Manager will work closely with the Hospitalists, PWL clinical staff, hospital staff, and health plan personnel to ensure a successful program. 

The ideal candidate will possess:

Minimum bachelors degree or higher in health sciences, health care administration, or business; A clinical license such as an RN, LVN, or PA is a plus, but not required; Minimum of six (6) years experience in a healthcare setting with the most recent two (2) in a managerial capacity; Must have experience working with hospital based physicians, a medical group, or IPA, with a strong understanding of clinical efficiency programs; Excellent communication (verbal and written), interpersonal, organizational and leadership skills; Strong written communication skills with understanding of “proposal or performa” concept documentation; Ability to communicate effectively with a wide variety of individuals, including physicians, nurses, health plans, hospital administrators, patients, patient families; Ability to demonstrate flexibility and is self-directed; Ability to function effectively as a member of an inpatient management team with an understanding of managed care principles; Understanding of managed care financial arrangements such as capitation and risk pools’ Ability to participate in, and where appropriate lead, clinical and operational committees, present data, defines goals; identify potential areas of concern and areas for quality improvement; and a solid understanding of basic computer system capabilities as it would pertain to the administration of a hospitalist group for day-to-day management including reporting and trending of operational statistics.

Job Title:  Manager, RN, Inpatient Services

Job responsibilities include the following:

Responsible for providing management services and assists the Medical Management Team in the areas of: (1) program development, implementation, maintenance and success monitoring (2) NCQA department compliance, (3) supervision of designated case management nurses, coordinators and support staff.

SUPERVISORY RESPONSIBILITIES:

Manages exempt and non-exempt employees.  Is responsible for the overall direction, coordination and evaluation of these employees.

Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws.  Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

The ideal candidate will possess:

Graduate of an accredited School of Nursing; Minimum of 5 years recent managed care case management experience; Minimum of 3 years recent management experience in an IPA or managed care environment; Understanding of Community resources in care management; Ability to analyze utilization data; Thorough knowledge of HMO, IPA, and managed care business concepts and principles; Excellent organizational skills; and the ability to manage stressful situations with poise and professionalism. 

Job Title:  Manager, RN, Special Programs

Job responsibilities include the following:

Responsible for providing administrative support for Director of Care Management in the areas of: (1) system integration, (2) NCQA department compliance, (3) supervision of designated senior nurses and staff (department of approximately 38 full-time employees), with 150,000 membership plus with 14 health plans.

SUPERVISORY RESPONSIBILITIES:

Manages exempt and non-exempt employees.  Is responsible for the overall direction, coordination and evaluation of these employees.

Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws.  Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

The ideal candidate will possess:

RN License; 2 years related experience and/or training; five years supervisory/management experience.  Graduate of an accredited School of Nursing; Minimum of 5 years recent managed care case management experience; Minimum of 3 years recent management experience in an IPA or managed care environment; Understanding of Community resources in care management; Ability to analyze utilization data; Thorough knowledge of HMO, IPA, and managed care business concepts and principles; Excellent organizational skills; and the ability to manage stressful situations with poise and professionalism. 

Job Title:  Case Manager, RN, Ambulatory Services

Job responsibilities include the following:

Responsible for establishing departmental goals and objectives consistent with the mission and goals of the organization, selecting and retaining qualified staff, and maintaining efficient work processes to meet the needs of all the stakeholders.

The ideal candidate will possess:

California RN License; 5-7 years clinical RN experience: 5 years supervisory/management experience.

Job Title:  Case Manager, RN, Skilled Sub Acute Care

Job responsibilities include the following:

Responsible for functioning as a central point person for a continuity of care plan for all Monarch members moving to the sub-acute level of care.  Provides concurrent review and necessary social services for the frail sub-acute patient in collaboration with the geriatric nurse practitioner and Medical Director.

The ideal candidate will possess:

California valid RN license required; minimum Associates degree from a two-year college or university in a related healthcare field.  Knowledge of managed care operations preferred.  Strong discharge planning experience.  BSW with focus in geriatrics preferred.

Job Title:  Case Manager, RN, Inpatient Services

Job responsibilities include the following:

Responsible for implementing a continuity of care plan for the hospitalized Monarch member utilizing Milliman Guidelines. Provides on site and/or telephonic concurrent review and direction for hospital staff in discharge planning.

The ideal candidate will possess:

California valid RN license required; minimum Associates degree from a two-year college or university in a related healthcare field (managed care, discharge planning, QI, utilization review).  Skills should include service orientation, excellent oral (telephone) and written communication, negotiation, diplomacy, health promotion and training.

Job Title: Quality Improvement Specialist, RN

Job responsibilities include the following:

Responsible for performing activities of the QI department including site and medical record audits, grievance resolution, medical record data collection and audits.

The ideal candidate will possess:

California valid RN license, excellent verbal and written communication skills, negotiation, diplomacy, health promotion and training.

Job Title:  Coordinator - Special Programs

Job responsibilities include the following:

Responsible for the support the Case Management (CM) Nurse(s). Assists with the processing of patients enrolled in Special Programs for optimal quality of care and timely transitions

The ideal candidate will possess:

High School Graduate, some college preferred; Minimum of 3 years working experience; Managed care experience preferred.

Job Title:  Coordinator - Ambulatory

Job responsibilities include the following:

Responsible for reviewing requests for authorization and referrals and process according to Utilization Management Guidelines, policies and procedures.  Works with all teams and members of UM and/or CM to ensure authorization requests are processed in a timely manner.

The ideal candidate will possess:

High school diploma or general education degree (GED); one to two years related experience and/or training depending on level of entry; or equivalent combination of education and experience; Working knowledge of medical terminology and coding experience utilizing CPT and ICD-9 codes;  Typing skills, greater than 50 WPM; must have word processing skills with Microsoft Word.

CUSTOMER SERVICE:

Job Title:  Customer Service Manager

Job responsibilities include the following:

Responsible for enhancing customer satisfaction and retention of membership growth with health plans.  Supervises the Customer Service Supervisor and Customer Service Representatives (CSR) and proactively identify opportunities for strengthening and improving quality standards.

SUPERVISORY RESPONSIBILITIES:

Directly supervises employees of department.  Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

The ideal candidate will possess:

Prefer college degree in business, combination of High School and 5+ years experience in a customer service management position in the health care industry is helpful.  Demonstrated ability to proactively identify and resolve customer services issues.  Results oriented person required.

FINANCE DEPARTMENT:

Job Title:  Accountant

Job responsibilities include the following:

Responsible for assisting in a broad range of accounting duties requiring comprehensive knowledge of general accounting methods.

The ideal candidate will possess:

Bachelor’s degree in accounting or finance required; A minimum of 3 to 5 years progressive financial experience within an IPA, hospital or health plan setting is highly desirable; Advanced experience with MS Excel; Experience in Access, PowerPoint and Word preferred; Strong analytical approach and continual sense of good judgment and dependability; Strong industry knowledge;  Strategic thinking and good communication skills; and a firm understanding of GAAP and strong financial modeling capabilities. Must also be detail oriented, deadline driven and highly organized. Solomon/FRX Report Writer experience a plus.

Job Title:  Financial Analyst

Job responsibilities include the following:

Responsible for assisting in performing month-end close process and related financial analysis, including tracking and reporting critical trends in financial position for Company’s clients.

The ideal candidate will possess:

Bachelor’s degree (B.A.) from four-year college or university and a minimum of 5 years progressive financial experience within an IPA, hospital or health plan setting required; Excellent proficiency with MS Excel and experience in Access and PowerPoint preferred;  Strong analytical approach and continual sense of good judgment and dependability;  Strong industry understanding; Strategic thinking and good communication skills; Firm understanding of accounting practices under GAAP and strong financial modeling capabilities required. Must also be detail oriented, deadline driven and highly organized.

INFORMATION SERVICES DEPARTMENT:

Job Title:  I.S. Manager

Job responsibilities include the following:

Responsible for managing and maintaining the day-to-day company’s technology systems; these include computer room, network, telephone and related infrastructure; overseeing the support desk process, staff scheduling and work flow; providing guidance to technicians for troubleshooting issues and escalations, re-assignments of tasks, and project work; and communicating with staff and managers on complaints and service issues; The Information Services manager works under the general direction of the IS Director. Superior communication skills (written and verbal) between the IS Director, IS Staff, Physician WebLink Staff and Senior Management are essential.

The ideal candidate will possess:

Bachelor's degree (B.S.); or 4-8 years or equivalent education and experience; Minimum 2 years technology and staff supervisory role; Minimum 3 years experience of Microsoft Office and Windows support; Minimum 5 years technology experience including Networking, Computer Operations, Help Desk, Backup  Systems, Microsoft Operating Systems, and Microsoft Database Servers; Advanced knowledge of Microsoft Word and Excel.  Good interpersonal and organizational skills.  Good written and verbal communication skills.  Ability to manage multiple priorities and projects;  Telephone system support and HealthCare industry experience preferred; Strong customer focus; 

NETWORK MANAGEMENT DEPARTMENT:

Job Title:  Administrative Assistant – Network Management

Job responsibilities include the following:

Responsible for assisting the Director of Provider Network Management and staff with all administrative duties involving the department. Schedules meetings, handles incoming phone calls, drafts and distributes correspondence, prepares reports and maintains files.

The ideal candidate will possess:

High school diploma or equivalent; 1 year of related experience and/or training; or an equivalent combination of education and experience.  Working knowledge of managed care industry, Customer Service and Provider Relations background helpful.

Job Title:  Specialist – Network Management

Job responsibilities include the following:

Responsible for operational activities related to the needs of Monarch providers.  Responsible for client service training, Provider Manual maintenance, claims and authorization training and technology training to meet the needs of local and national networks.

The ideal candidate will possess:

BA/BS degree, preferably in a health care related field; with five years related health care experience; or equivalent combination of education and experience; Minimum of three years HMO or related experience with excellent organizational, oral/written communication skills, and interpersonal skills;  Must be proficient in Microsoft Word, Excel, Access and internet  technologies;  Must also be detail-oriented and be able to speak in front of large groups, audience can range from 1 to 150 individuals;  Typing; Microsoft Office; EZ-Cap knowledge; valid California drivers license.

REPORTING and ANALYSIS DEPARTMENT:

Job Title:  Data Analyst

Job responsibilities include the following:

Responsible for analyzing, measuring and identifying key measurements and trends to assist in operations and financial management; Designing, running and maintaining a library of reports to support operational departments regarding medical costs, utilization, provider performance and patient outcomes; and effectively communicating results of analysis.

The ideal candidate will possess:

Bachelor’s degree in Computer Science/Information Systems, Business Administration, Finance, Mathematics/Statistics, Healthcare Management, Economics or other related fields; Three years IPA and/or HMO healthcare related experience, preferably in financial planning, analysis and programming, building forecasting tools to measure and monitor data and utilizing software for analyzing and mining data; Advanced training or certification in SQL, Data Warehousing, Cognos/Crystal/Business Objects or other reporting tools; Excellent working knowledge of Microsoft Excel, Access and PowerPoint; Proficiency with Data entry, Microsoft Word, Microsoft Excel preferred; Ability to multi-task; Excellent organizational skills; and Self-motivation a must.

SALES AND MARKETING DEPARTMENT:

No current openings.

North Carolina

 Physician WebLink of NC, providing management services for PrimaHealth IPA and DukeHealth Direct is actively recruiting the following position(s):

 CLINICAL SERVICES DEPARTMENT:

Job Title:  Project Manager – Prospective Health

 Job responsibilities include the following:

Responsible for providing comprehensive care management for members in the inpatient and outpatient setting by collaborating with hospital staff to facilitate patient transfers to the most appropriate level of care.   The care manager identifies members  who are appropriate for one of the Population Management programs, then develops, implements and manages a continuity of care plan designed to maximize the potential for a positive outcome while facilitating care and cost effective services for the member.

 The ideal candidate will possess:

Registered nurse with a current North Carolina license, Certified Case Manager (CCM) certification required with a minimum of three years of acute care experience and recent case management, disease management or population management experience.  Experience such as pre-certification, concurrent review, discharge planning, case management and/or home health nursing is required.  Skills should include service orientation, excellent oral and written communication, problem solving, negotiation, diplomacy, health promotion and training. 

NETWORK MANAGEMENT DEPARTMENT:

No current openings.

PWL focuses on keeping our employees happy, challenged and growing by providing the following ...

     * Promote-from-within Policy

     * Performance-Based Recognition

     * Competitive Salaries & Benefits

     * Direct Deposit

     * 401K Plan

     * 40 hour work weeks – no weekends!

     * Referral Bonuses

     * And much, much more!

Take this opportunity to challenge yourself!

 If you are looking for a challenging and rewarding position with a highly reputable organization, please submit resume and salary history to the following: jobs@pwlink.com or fax to 949.923.3592, ATTN: Lauren. No phone calls please.