Health Plan Associate

A Health Plan Associate job in San Francisco, CA is available through Adecco Medical & Science. Our client is a family of community-based, not-for-profit organizations whose mission is to relentlessly pursue quality of life and quality of care for older adults and their families. Under the direction and supervision of the Health Plan Manager, the Health Plan Associate implements and performs health plan functions and duties as assigned.

DUTIES / RESPONSIBILITIES:

Handle and process grievances and appeals for health plan members. Tasks include interviewing staff, participants, and caregivers in response to grievance or appeal; investigating to gather facts; drafting resolution letters and notices; ensuring timely processing of requests; coordinate, schedule, and facilitate internal Appeals Committee meetings.
Process enrollments and disenrollment’s for Medicare and/or Medi-Cal eligible enrollees to the respective Regulatory agencies.
Manage member grievance hotline on daily basis.
Handle logistics and minutes for quarterly Plan Policy Committee for organization.
Coordinate all appeals involving fair hearing requests, including preparing documentation and scheduling with external appeal board.
Coordinate various participant-directed surveys, including Medicare Health Outcomes Survey-Modified (HOS-M) and satisfaction surveys. Tasks include working with vendor and educating staff and participants.
Coordinate member communications, including those related to changes in primary care provider, out of area travel, and disenrollment.
Coordinate linguistics program for health plan, including managing third party interpretation services.
Coordinate submission of reports to appropriate regulatory agencies, including CMS, DHS and DMHC, as assigned.
Assist supervisor to review and comment on health plan policies and procedures as needed.
Performs tasks related to Licensure and Audits as necessary.
Query reports from the Data Warehouse as assigned.
Understand and track functions delegated to subcontracting entity, Institute on Aging (IOA), as outlined in the contract between On Lok and IOA as well as in On Lok’s Quality Assurance and Improvement Plan (QAIP) including coordinating and participating on IOA Oversight Committee.
All Other Reasonably Related Jobs as Assigned.


QUALIFICATIONS (knowledge, skills, abilities):

Bachelor Degree from an accredited university.
At least 3 years’ experience in health-care preferred.
Experience in Managed Care field preferred.
Knowledge and experience in project management, data collection, statistical analysis and preparation of reports.
Ability to act as an advocate for the frail elderly with all groups served in the program.
Flexibility, creativity and ability to work with an ethnically diverse group of clients and employees



If you are interested in this Health Plan Associate job in San Francisco, CA then please click APPLY NOW. For other opportunities available at Adecco Medical and Science go to www.adeccousa.com. If you have questions about the position or would like more information, please contact Sindie Rothstein at 858-410-1108 or by email at Sindie.rothstein@adeccona.com

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Reference number US_EN_2_108218_334599