California Department of Managed Health Care ยท 1 day ago
Initial Review Lead Analyst
California, United States
Full-time
Hybrid
Mid, Senior Level
$6,031/mo - $7,547/moThe California Department of Managed Health Care (DMHC) is dedicated to ensuring health plan members have access to equitable and high-quality health care. The Initial Review Lead Analyst will act as a subject matter expert, responsible for performing case audits, analyzing, and triaging Independent Medical Review Applications and complaints against health plans, while also developing training materials within the Initial Review Section.
ComplianceGovernmentHealth Care
Responsibilities
Perform case audits, screening, analyzing, and triaging Independent Medical Review (IMR) Applications and incoming complaints against Knox-Keene licensed health, dental, vision, mental health, and other specialized health plans
Implement, monitor, and evaluate health program activities
Assess and develop training material within the Initial Review Section (IRS)
Qualification
Required
The position(s) require(s) a Background Investigation be cleared prior to being hired
Possession of Minimum Qualifications will be verified prior to interview and/or appointment
If you are using education to meet the minimum qualifications for this position, you must submit a copy of your high school transcripts or college/university transcript(s)
Statement of Qualifications - The Statement of Qualifications (SOQ) is a MANDATORY requirement to apply for this position
Your statement should be typed, Arial 12 pt. font and no more than two pages in length
Your SOQ must address the following: What is your experience working with public health, mental health or health care services programs and issues? Describe your experience applying laws, health care regulations, policies and procedures, analyzing complex health care issues and recommending effective action. Describe your experience providing training or auditing. Please include methodological approach into training, auditing, and reporting including feedback and recommendations
Applicants who do not submit a SOQ with their application packet, in accordance with the instructions will be disqualified from consideration for this position
Preferred
Knowledge of principles, practices, and trends with health care insurance
Experience working in health programs/program operations
Ability to work in a fast-paced and customer service-oriented program environment and to organize/prioritize workload to meet demands
Experience leading teams and management a high volume caseload
Ability to perform multiple tasks with accuracy, precision and neatness
Ability to thrive and work within a team environment
Ability to provide accurate, clear, and timely advice and direction
Independently resolve complex issues within a short timeframe
Provide excellent oral and written communications
Demonstrated ability to act independently, with open-mindedness, flexibility, and tact
Ability to work well independently and in a team while working remotely or in an office environment
Ability to cultivate collaborative and cohesive working relationships with people in and outside of the team
Knowledge and proficiency in the use of personal computers and standard office software (i.e. Teams, Outlook, Word, Excel and PowerPoint)
Company
California Department of Managed Health Care
California Department of Managed Health Care is a government body that provides health plan oversight and consumer complaint assistance.
Founded in 2000
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Chris Jaeger, MD, MBA
Chief Medical Officer
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