Employment Type : Full-Time
ResponsibilitiesSUMMARY: Maintaining compliance with regulatory requirements with CMS and DMHC. Ensure compliance in timeliness in decisions, initial notifications, and written notifications. Assist Health Plans in audits. Maintain denial templates as mandated by CMS and DMHC. Collaborate to prepare for National Committee for Quality Assurance reporting and submission. Attend Industry of Collaboration Efforts Webinars and communicate changes to Utilization Management staff. Ensure compliance of staff with Language Assistance Program Requirements for LEP members. QualificationsQUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
CERTIFICATES, LICENSES, AND REGISTRATIONS: None.