Job Summary. The Gastroenterologist will be responsible for treating up to 20-25 patients a day in a busy Outpatient Clinic – University Chest Medicine. Essential Job Functions. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position. Treat patients in an outpatient setting. Perform outpatient endoscopies on an as needed basis. Treating conditions including: inflammatory bo...
Job Summary. Responsible for customer service calls from providers in assisting callers as it relates to the claims adjudication. Acts as the “first impression” person representing RCMG to callers. Provide claim status and assistance as directed by Supervisor. Research and respond to eligibility claim issues. Essential Job Functions. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions ...
River City Medical Group, Inc., a Vivant Health Company, is seeking a Pulmonologist (Internist) for its Pulmonary Clinic: University Chest Medicine. River City Medical Group, Inc. (RCMG) has deep roots in service to the Sacramento Medi-Cal and Medicare population and University Chest Medicine provides direct outpatient care to generations of families in our network. University Chest Medicine also has a strong partnership with California Northstat...
Job Summary. Under the direction and oversight of the Supervisor of Utilization Management, the Senior Inpatient Utilization Review Nurse. is responsible and accountable for coordination of services for members of River City Medical Group admitted to and/or discharged from an inpatient acute or skilled facility as well as outpatient services as delegated. The Senior Inpatient Utilization Review Nurse coordinates all systems/services needed for an...
Job Summary. Collaborates closely with the provider community to identify and resolve issues, provide education, and staff training, and to ensure compliance with our providers. Maintains accuracy of provider manuals, bulletins, and communications with provider offices. Interface with the HMO liaisons on provider issues. Assist with provider network contracting activities. Additionally serves as a resource to junior provider relations representat...
Job Summary. Reporting to the Claims Supervisor, the Eligibility Specialist is primarily responsible for verifying and confirming member eligibility and notifying health plans when appropriate. Essential Job Functions. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position. Verify member eligibility between eligibility uploads and add/update member profiles. Confirm health...
Job Summary. The Human Resources Coordinator provides support for various HR functions within the organization. The incumbent will assists with the administration of the day-to-day operations of the human resources functions and duties. Responsibilities include duties in some or all of the following functional areas: Benefits/Compensation, Talent Acquisition, Employee Relations, HR Data Management, Leaves of Absence, New Hire Orientation, and oth...
Job Summary. Under the direction of the VicePresident Program Development/Community Relations provide direct counseling to members about availability of entitlement and social service programs. Identify members with unmet social needs and complex medical conditions. Serve as a Company liaison to county and community-based programs. Assist members to apply for programs that remove barriers to access healthcare. Essential Job Functions. Reasonable ...
Job Summary. The Community Support Services Navigator works one on one with members to identify and reduce barriers to care by identifying needs and linking members to sources of emotional, financial, administrative, or cultural support. In addition, the Community Support Services Navigator helps educate members of the importance of preventive care and the maintenance of the medical home. The Community Support Services Navigator is a health care....
Job Summary. UM Coordinator l coordinates and supports activities related to authorization processing for outpatient, inpatient and ambulatory services. Compiles daily inpatient log. reviews specified UM reports. processes referrals, completes denial letters and performs retro-review coordination. QM coordination of grievances/activities/QOC, and CCS related activities. Acts as liaison to the providers' offices and the UM/QM staff. Provides cleri...
Job Summary. Responsible for the accurate and timely processing of routine HCFA and UB claims and adjustments to previously processed claims. Responsible for the completion of failed claims that consist of eligibility research and coding. Responsible for eligibility confirmation. Performs basic clerical duties involved in supporting the Claims Department. Essential Job Functions. Reasonable accommodations will be made to enable individuals with d...
