14 jobs found in cypress

Beacon Health Options Job Category: Operations - Quality Req #: CORPC01927 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Corporate Complaints and Grievances Coordinator a highly organized and compassionate professional to join our team at our Cypress, CA office. The Complaints and Grievances Coordinator I (CGC1) is responsible for providing best in class customer service for all member encounters received into the organization across 5 regions. The CGC1 is responsible for the processing, tracking and follow up of all complaints and grievances. This individual is required to have excellent communication and organizational skills, the ability to work cooperatively with health plan Quality Management, and Ombudsperson team, the ability to provide excellent customer service to providers and members, and the ability to perform in potentially stressful situations, such as state, federal, NCQA, URAC or other regulatory/accrediting agency audits What does a typical day look like? Maintain a current knowledge of plan products, policies and procedures with the ability to relate this information in a clear, concise and understandable manner to member, providers, and other customers, both internal and external.Maintains systems, processes, and contract adherence across 5 regions for the timely and accurate resolution of all complaints, grievances, including appropriate routing of potential adverse incidents and/or quality of care encounters. This focus includes the tracking of information via the Complaints and Grievance Log, sending acknowledgement and resolution letters to providers and members within established time frames.Maintains systems and processes for the timely and accurate resolution of all complaints and grievances (as delegated); and ensuring compliance with all relevant regulations, accrediting standards, policies and procedures.Receive, record, and triage, adverse incidents (AIs), and Quality of Care concerns (QOCs) to region Ombudsperson or other designated staff in a timely manner.Manage the receipt, investigation and resolution of standard complaint issues in a timely and highly effective manner.Interface with the appropriate Beacon management and staff at all levels to present and summarize complaint and grievance cases.Maintain confidentiality of all protected health information in accordance with state and federal guidelines and corporate policies and procedures.Maintain knowledge of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions as necessary.Complete projects and other research tasks as assigned by area management.When complaints and grievances are not delegated to Beacon, the Complaint and Grievances Coordinator sends to the health plan, by secure fax, all information requested as part of the established review process from the FlexCare and or Connects system. S/he enters the complaint and or grievance into the Complaints and Grievances Log.Maintains up to date Complaints and Grievances Logs that are in compliance with all state, federal, NCQA, URAC and other regulatory agency standards / regulationsOther duties as assigned. What you Contribute? Education : A high school/GED diploma is required. An Associate degree or Bachelor's degree in Human Services (Social Work, Psychology, and/or Sociology) preferred. Licensure : N/A Knowledge, Skills & Abilities: Minimum One to two years' experience in resolution of complex issues in Customer Service or a related field is preferred. Managed care experience preferred with knowledge and experience in benefits and member contracts required. Must be well versed in all aspects of complaints as they relate to the grievance and appeal process required. Ability to process all types of correspondence handled by Complaints and Grievances across the enterprise is required. Excellent communication skills (verbal, written, interpersonal, and presentation) required. What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PI116264947

Beacon Health Options Job Category: Operations - Customer Service General Req #: CUSTO01860 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Customer Service Representative I to join our team at our Cypress, CA office. Under the direction of the Customer Service Management Team, the Customer Service Representative (CSR) for answering and responding to a high volume of telephone inquiries from members and providers. The incumbent's responsibilities include providing accurate and thorough interpretation of benefits, eligibility, provider participation, claims payment and interpretation inquiries, resolving customer inquiries, facilitating problem resolution, and acting as a member/provider advocate by meeting or exceeding customers' expectations. The CSR is expected to take complete responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention and satisfy corporate customer service goals and objectives. Shift : M- F 9:30 am - 6:00 pm (schedule may vary) What does a typical day look like? Essential Duties and Responsibilities: The CSR will perform the following duties in a typical call center environment, which means a high volume of calls will handled while located at a desk. Which requires adherence to schedules and extended periods of time on the phone. Provide timely, accurate, and courteous responses to a high volume of telephone inquiries from both members and providers.Meet daily production standards as indicated by management to meet overall ASA/ABA and client PG's: includes attendance, adherence to schedules, ACW, calls per day, turnaround times.Maintain adherence to schedule enabling the team to meet client satisfaction levels. Adherence to work schedule including time spent on break/lunch.Achieve and maintain productivity and quality performance expectations; minimum 95%Interpret and effectively communicate benefits and eligibility and claims payment information to our customers.Document all critical information related to contacts responded to in the appropriate in house healthcare systemsDemonstrate professionalism, empathy and a sense of urgency on each and every member and provider call/transactionEffectively navigate through multiple complex systems/screens.Have the knowledge around handling escalated callsProvide timely follow-up with other internal departments to expedite resolution of difficult/aging inquiries, and when necessary escalate those issues to management for further handling.Keep abreast of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions and department meetings as necessary.Complete daily assigned tasks by management such as website inquiries, COB coordination of benefit updates, and authorization for disclosure forms, authorization updates, and correspondence.Perform additional duties and/or work additional hours as needed. Overtime and working holidays may be required based on business needs.Comply with all the HIPAA Compliance regulations. What you Contribute? Education : A high school/GED diploma is required. An Associate's Degree or equivalent related experience is preferred. Licensure : N/A Knowledge, Skills & Abilities: 6 months - 1 year experience in Customer Service, Health Care or Health Insurance is required. Previous experience in an ACD call center environment is preferred. Strong interpersonal skills and good written and verbal communication skills. Computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint. What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PI116224865

Beacon Health Options Job Category: Clinical - Care Mgmt Req #: DIREC01730 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Director, Clinical Services a highly organized and compassionate professional to join our team at our Cypress, CA office. The Director, Clinical Services is responsible for clinical oversight of Utilization Management in the West Region. The primary focus of this position is to ensure that the delivery of quality clinical care and service to health plan members meets NCQA, URAC, and State, federal and contractual requirements. The Director, Clinical Services works in collaboration with the AVP, Clinical Services to ensure the clinical operational needs of the organization are met. What does a typical day look like? Clinical oversight of all utilization management services in the West Region Participates in and oversees compliance with internal audits and external client UM audits Identifies opportunities to streamline workflows that result in accurate, high quality production standards and improved results in cost savings, or outcomes measurement Complete annual evaluations and program descriptions for UM programs Development of custom UM reports if indicated and monitors all UM key performance indicators Tracks and monitors all metrics related to UM program, implements plans for improvement as necessary Collaborates and helps coordinate Peer Review process Oversight of the development of and adherence with organizational and state specific UM policies and procedures Monitors the census across all lines of business Provides direction to Managers in the reporting and analysis of plan specific UM metrics In collaboration with the AVP, Clinical monitors utilization management trends and formulates strategies to manage costs Participates in new business opportunities including requests for proposals Directs UM programs in the development of clinical programming to improve the health outcomes of the members we serve Represents Beacon at client meetings regarding clinical issues Resource to the AVP, Quality on all NCQA and URAC initiatives and readiness Periodic consultation with practitioners in the field through attendance at site visits, professional meetings and conferences as well as through membership on various committees, i.e. Provider Advisory, Clinical Management, etc. to which practitioners are invited What you Contribute? Education : Master's degree or higher in a health related field and independent licensure as a behavioral health professional required. Licensure : Current, valid and unrestricted licensure for practice required with proof on date of hire. Re-verification will take place no less than every 2 years. Valid State Clinical License required (RN, LCSW, LMFT, PhD or PsyD) Knowledge, Skills & Abilities: 4-5 years behavioral health managed care experience preferred. Experience with financial and clinical data analysis and reporting required. The ideal candidate will be organized, creative, and have strong verbal and written communication skills and will be experienced in managing cross-functional/cross-departmental priorities. Experience with Behavioral Health Utilization Review, Case Management and technical operations in a managed care setting is preferred. Strong background operations management and supervisory experience preferred. Project Management experience preferred. Self-motivated, able to effectively prioritize in a fast paced environment. Can-do attitude and ability to work collaboratively with internal staff and external partners. What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PI115938031

Beacon Health Options Job Category: Clinical - General Req #: ABACL01801 Schedule: Full Time Location: CA - Cypress About the Position: We are currently seeking a dynamic ABA Clinical Services Assistant II to join our Utilization Management team in Cypress, CA! The ABA Clinical Care Services Assistant II serves as central point of contact and communication for members, families, providers, insurers and members of the ABA team in the linkage of care for Applied Behavioral Analysis (ABA) services. Addresses a broad spectrum of needs and/or concerns in a professional, friendly, and efficient manner. Performs a variety of customer service and unit-operations activities to assist clinical and administrative staff to meet operational and business performance metrics. Position Responsibilities: Assist members and providers with all levels of inquiries, problem solving, insurance information and general customer service, which could include: Customer material requests and member registration Benefit and Eligibility information Physician assignments Authorization for treatment Billing and Payment issues Explanation of Benefits (EOB)/Explanation of Payments (EOP) Clinical Care Management system usage Staff all Call Center queues and adhere to performance requirements for call center response times, abandonment rates, and other productivity, schedule, and quality standards or metrics that may be established. Receive, respond and resolve questions about accessing ABA services. Analyze data and identify appropriate level of care to expedite linkage to care to ABA services. Gather required clinical and financial information care for members and enter data into clinical care management system. Monitor the data in the clinical care management system, collaborating with provider community; escalate issues and concerns regarding care management to Senior Care Managers according to policies and procedures. Act as a liaison with parents and the health community to ensure continuum of care and support for members. Participates in corporate quality improvement functions. Assists with special projects and administrative tasks as assigned. Performs other duties as required. Position Requirements: Education: High School diploma or GED equivalent required Relevant Work Experience: 5 years' general working experience with 2 years' of Customer Services experience required Knowledge, Skills, & Abilities: Previous experience in a call center environment within the healthcare preferred Knowledge or ability to learn state and federal laws and regulations applicable to the call center required Strong analytical, problem solving and organizational skills required Strong interpersonal skills needed to frequently interact with members, families, providers and insurance representatives required General knowledge of clinical documentation, preferably electronic health records/medical records systems preferred Ability to learn, master, and incorporate use of variety of clinical and administrative automated systems and software into daily work required Bilingual in English and Spanish preferred To Apply: Click below on " Apply for this Position " to create a profile and apply for the position Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PM16 PI115938047

Beacon Health Options Job Category: Clinical - Care Mgmt Req #: UMCAR01497 Schedule: Full Time Location: CA - Cypress About The Position: Beacon Health Options is currently seeking a dynamic UM Care Manager to join our Outpatient team in Cypress, CA or remotely! The UM Care Manger Outpatient Licensed Clinician is a position in fast-paced environment that serves the members population seeking behavioral health services. The Care Manager is responsible for screening and triaging members to appropriate level of care and providing resources and referrals. This is an Evergreen requisition designed to gather a talent pool for current or future open positions. It is a way for Beacon Health Options to build a network of qualified, interested candidates for a specific job function in order to expedite the hiring process when there is a need to fill that type of role. By applying to an Evergreen requisition, you are expressing your interest for a particular job function within Beacon Health Options. In addition to submitting your resume to an Evergreen requisition, we encourage you to create a job search agent to be alerted when positions in your areas of interest become available. Position Responsibilities: Responds to screening and triaging members telephonically to determine appropriate level of care Utilization Review with providers based on claims trigger data and 6 month reviews Work collaboratively to coordinate a supportive environment and clear communication; Maintaining accurate information in Beacon's clinical documentation systems as directed Telephonic collaboration with provider and county agencies regarding members in treatment Participation in systems meetings as needed Collaborate with Primary Care Physician (PCP), Behavioral Health Professionals (BHP), and other members of the health care team, including health plan medical care managers and others to arrange and coordinate services for the member and optimize the member's ability to engage in the appropriate plan of care; Assist with NCQA and URAC initiatives Respond to urgent calls Telephonic collaboration with Members Treatment Record Reviews Attend Clinical meetings Adheres to all Beacon policies and procedures and standards of operations. Completes all required and assigned trainings. Attends all mandatory company or department meetings. Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment. Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work. Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members. Assist team members and offers suggestions to improve processes, culture, or work environment. Performs special projects and other duties as assigned and required. Telecommunicating an option Position Requirements: Education: Bachelor of Science in Nursing (BSN) or master's degree in mental health related discipline. Licenses: Licensed behavioral health clinician/nurse (LCSW, LMFT, LPCC, RN, Ph.D. or PsyD.) required in the state of California, certification as a Care Manager is preferred. Relevant Work Experience: 3 years behavioral health clinical practice required Knowledge, Skill, & Abilities: Educated in current principles and procedures of behavior health care. Knowledge of managed care and state specific expertise preferred. Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes. Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up. Strong interpersonal skills and good written and verbal communication skills. Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint. To Apply: Click below on " Apply for this Position " to create a profile and apply for the position Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PM16 PI115937975

Beacon Health Options Job Category: Clinical - Quality Mgmt Req #: DIREC01194 Schedule: Full Time Location: CA - Cypress About The Position: We are currently seeking a dynamic Regional Director of Quality Performance Improvement to join our team at our office in Cypress, CA. The Director of Quality Performance Improvement is responsible for Quality and performance improvement projects, both those generated internally and those conducted in collaboration with external organizations, and oversight of related Quality Management departmental activities including data management, statistical analysis, and report writing. Facilitates clinical and service quality improvement through data analytics and problem-solving techniques. Position Responsibilities: Oversees performance measurement and improvement operations Creates methodologies to assess P4P attainment for custom behavioral health measures Leads interaction between Regional clients regarding HEDIS and QI. Develops an organized system for monitoring P4Ps, SLA, PGs, etc. and performs risk assessment on attainment and develops action plans for reaching targets, trending performance over time to set benchmarks and predict attainment. Helps teams in the region develop measurement plans that are concordant with Corporate measurement strategies. Participate in HEDIS audits from external vendors with clients. Leads HEDIS and performance improvement workgroups for the region. Reports to Corporate Quality on progress of QIAs and leads regional participation in corporate HEDIS workgroups. Analyzes clinical data for clinical quality improvement and leads clinical teams in intervention design and measurement. Uses data sources across clinical department to improve performance on UM and CM outcomes. Works with Provider Quality to improve. Applies strong plan-do-check-act continuous quality improvement strategies for monitoring success of implementations. Mines data regularly and is responsible for innovating new design or process improvement solutions. Develops custom behavioral health measures using small tests of change and other statistical techniques. Streamlines operations by defining and implementing data collection, monitoring, and evaluation to determine intervention success. Facilitates workgroups for quality improvement projects. Makes recommendations to the quality operations committee to improve quality of services provided to Members. Determines strategies for assessing effectiveness of interventions. Develops, design, and manage internal research projects and quality improvement activities. Provides consultation to the organization regarding data needs and data analysis. Completes formal reports documenting research efforts, methodologies, outcomes, and recommendations for ongoing research projects and quality improvement efforts, such as, but not limited to EQRO, NCQA, Member and Provider surveys, pay-for-performance reports. Leads Trilogy document completion for the Region, legal entities, State direct, and Health plans. Assists the Assistant Vice President of Quality in strategically implementing vision of the quality department using strategic goals and measuring success. Supports the leadership in identifying opportunities for improvement that supports corporate goals and implementations. Knowledge, Skills & Abilities: Knowledge of HEDIS and performance improvement metrics; building custom reports and mechanisms for evaluating program performance; skilled at excel and other statistical packages, such as SAS, STATA, SBSS. Works well across teams with excellent communication skills, both verbal and written. Innovative in project design and proven track record in project management. Quality management skills can be used across a variety of projects, including accreditation standards and tracking of policy and procedures. Proactively implements corrective action plans and measures improvement; able to achieve buy-in from multiple stakeholders. High level of presentation skills and ability to communicate complex measurement and quality improvement design. Exhibits a high level of strategic and critical thinking. Strong communication skills, both oral and written Strong presentation skills Proficient with Microsoft Office Position Requirements: Education: Master's level education in public health, business, epidemiology, healthcare policy, or other relevant field. Relevant Work Experience: 3-5 years mental health/substance abuse experience; experience in project management and staff supervision desired. Experience implementing large and small-scale quality improvement process. Knowledge of quality improvement and associated measurement. Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. PI116120000

Beacon Health Options Job Category: Clinical - Aftercare Req #: AFTER01649 Schedule: Full Time Location: CA - Cypress About the Position: Beacon Health Options is currently seeking an Aftercare Coordinator to join our team in Cypress, CA! This position is responsible for scheduling aftercare follow-up for members discharging from an inpatient acute mental health setting. The Aftercare Coordinator ensures that members have a scheduled appointment in place, completes follow-up and reminder call to member and follows up with providers to ensure member's compliance with aftercare. The Aftercare Coordinator works closely with Transition of Care Clinicians, Utilization Management Clinicians, Case Management Clinicians and hospital Discharge Planners to assure compliance with HEDIS measure for follow-up after hospitalization. Position Responsibilities: Responsible for tracking daily assigned duties, case load and performance. Complies with FUH workflow and completes all the steps in the workflow. Interfaces with members, hospital staff, providers and provider office staff to coordinate aftercare for members. Verifies and updates eligibility information as needed. Responsible for documenting aftercare notes in member's file in a clear and concise manner and in the required section/module. Initiates aftercare process at time of notification of an inpatient mental health admission Coordinates aftercare with hospital Discharge Planner, Beacon Transition of Care Clinician, UM team and/or member's responsible party Schedules aftercare appointment for members prior to discharge and communicates appointment information to the hospital discharge planner, UM team and/or member's responsible party Responsible for mailing/faxing aftercare appointment information to members and hospital Makes outreach call to members after discharge to review aftercare appointment and complete appointment reminder. Encourages member to attend the scheduled aftercare appointment and provides information on importance of following up with a provider after discharge Follows-up with providers to obtain outcome of the scheduled appointment Responsible for outreaching to members who did not adhere to 7-day follow up appointment to offer 30-day appointment Responsible for mailing discharge aftercare letter with list of referrals to members not reached by phone. Responsible for tracking and collecting primary source verification for aftercare appointment when indicated. Attends and participates in monthly staff meetings. Trains new staff as assigned by department lead or director. Keeps copiers, printers and fax machines cleared of any protected health information. Documents receipt of time sensitive materials in the appropriate information system. Participates in monitoring department office supplies and notifies department director. Adhere to all Beacon policies and procedures and standards of operations. Completes all required and assigned trainings on time. Attends all mandatory company or department meetings. Report to each scheduled shift to commence work and perform essential job functions. Displays a professional, positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment. Performs special projects and other duties as assigned by department lead or director. Position Requirements: Education :High School diploma or GED required, Associates degree or higher preferred Relevant Work Experience: 2 years office experience required, healthcare or managed care experience preferred Knowledge, Skills & Abilities: Ability to maintain privacy and confidentiality in compliance with HIPAA regulations and policies Knowledge of Medicare & Medi-Cal Ability to deliver exceptional customer service to both internal and external customers Ability to multitask assignments to meet multiple deadlines and performance standards Ability to use electronic health record and electronic medical record software systems To Apply: Click below on " Apply for this Position " to create a profile and apply for the position! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #GD #CB PM16 PI116120002

Beacon Health Options Job Category: Provider & Network - General Req #: PROVI01900 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Provider Reimbursement Analyst a highly organized and compassionate professional to join our team. Develop and maintain the behavioral health professional reimbursement methodologies for existing, as well as new markets. Conduct benchmarking analysis of current fee schedules to Medicare and/or Medicaid. Conduct market research and analysis of OP provider fees and higher level of care contracting rates. Development and maintenance of company-wide, default provider rate sheets and fee schedules for distribution to key internal areas of operations and ensure approved fee schedules are entered into all appropriate data systems. What does a typical day look like? Develop/update and facilitate the annual loading of benchmark professional fee schedules (Medicare, Medicaid, and Beacon Proprietary) in conjunction with each Region's provider strategy.Serve as the subject matter expert regarding specific reimbursement, fee schedules and rates for new client implementations and upsells for existing clients. Execute implementation activities related to reimbursement.Monitor and assure implementation of cycle as well as off cycle code additions/deletions to benchmark fee schedule and update existing Beacon fee schedules for cross-walked codes.Analyze the financial impact of updated professional fee schedules for both risk and ASO business.Support the development, implementation and maintenance of desktop modeling tools for professional rate increases.Partner with System Advisor team to identify system design/architecture requirements for loading fee schedules.Utilize reporting tools to index facility rates by level of care and place of service as a percent of benchmark reimbursement levels.Support the Network Strategy department's process improvement and transformational initiatives to drive completion and successful outcomes.Develop strong relationships with Regional teams built on trust and collaboration.Act as liaison and maintain productive working relationships with all Beacon departments.Other duties as assigned. What you Contribute? Education : Bachelor's Degree required. Licensure : N/A Knowledge, Skills & Abilities: Three to Five (3-5) years of progressively responsible professional reimbursement experience. Three (3) years of provider relations and/or contracting experience preferred Two to four (2-4) years healthcare payor (including managed care) experience 2+ years of multi-state provider reimbursement experience preferred Experience and comfort with financial model and detailed data analysis What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD #LI-7CF1 PM16 PI116120005

Beacon Health Options Job Category: Provider & Network - General Req #: DIREC01901 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Director, Provider Reimbursement a highly organized and compassionate professional to join our team. The Director of Provider Reimbursement is a highly visible team lead among internal and external stakeholders. The Director of Provider Reimbursement leads a team of analysts that identify, define and update provider facility and professional fee schedules. This role also supports Beacon's provider reimbursement strategies as set forth by Market and Regional leadership, leveraging the organization's matrix structure to engage and coordinate support cross-functionally among key stakeholders. The Director of Provider Reimbursement is develops and maintains the behavioral health reimbursement methodologies for existing, as well as new markets for facilities and professionals. What does a typical day look like? Lead the development/updating and facilitation of the annual loading of benchmark facility and professional fee schedules (Medicare, Medicaid, and Beacon Proprietary) in conjunction with each Region's provider strategy.Serve as the Enterprise subject matter expert regarding reimbursement, fee schedules and rates for new client implementations and upsells for existing clients. Drive implementation activities related to reimbursement.Train and mentor team resources to build core reimbursement knowledge and promote analytical standards and best practices.Lead the implementation of cycle as well as off cycle code additions/deletions to benchmark fee schedule and update existing Beacon fee schedules for cross-walked codes.Facilitate/direct analytical resources to determine the financial impact of updated professional fee schedules for both risk and ASO business.Secure the appropriate grouping/pricing software necessary to support facility contracting for all lines of business in all Divisions/Regions.Lead the development and maintenance of desktop modeling tools for professional rate increases.Develop/utilize reporting tools to index facility rates by level of care and place of service as a percent of benchmark reimbursement levels.Support and participate in the Network Strategy department's process improvement and transformational initiatives to drive completion and successful outcomes.Develop strong provider and Regional relationships built on trust and collaboration. Manage and balance Beacon and provider expectations.Act as liaison and maintain productive working relationships with all Beacon departments.Other duties as assigned. What you Contribute? Education : Bachelor's Degree required. Licensure : N/A Knowledge, Skills & Abilities: Five - Seven (5-7) years of progressively responsible professional experience, with at least three (3) of those years with a provider-facing role Three (3) years of provider relations and/or reimbursement experience Three-five (3-5) years healthcare payor (including managed care) experience preferred 2+ years of multi-state provider management experience preferred Experience and comfort with financial model and detailed data analysis What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD #LI-7CF1 PM16 PI116120007

Beacon Health Options Job Category: Provider & Network - General Req #: PROVI01900 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Provider Reimbursement Analyst a highly organized and compassionate professional to join our team. Develop and maintain the behavioral health professional reimbursement methodologies for existing, as well as new markets. Conduct benchmarking analysis of current fee schedules to Medicare and/or Medicaid. Conduct market research and analysis of OP provider fees and higher level of care contracting rates. Development and maintenance of company-wide, default provider rate sheets and fee schedules for distribution to key internal areas of operations and ensure approved fee schedules are entered into all appropriate data systems. What does a typical day look like? Develop/update and facilitate the annual loading of benchmark professional fee schedules (Medicare, Medicaid, and Beacon Proprietary) in conjunction with each Region's provider strategy.Serve as the subject matter expert regarding specific reimbursement, fee schedules and rates for new client implementations and upsells for existing clients. Execute implementation activities related to reimbursement.Monitor and assure implementation of cycle as well as off cycle code additions/deletions to benchmark fee schedule and update existing Beacon fee schedules for cross-walked codes.Analyze the financial impact of updated professional fee schedules for both risk and ASO business.Support the development, implementation and maintenance of desktop modeling tools for professional rate increases.Partner with System Advisor team to identify system design/architecture requirements for loading fee schedules.Utilize reporting tools to index facility rates by level of care and place of service as a percent of benchmark reimbursement levels.Support the Network Strategy department's process improvement and transformational initiatives to drive completion and successful outcomes.Develop strong relationships with Regional teams built on trust and collaboration.Act as liaison and maintain productive working relationships with all Beacon departments.Other duties as assigned. What you Contribute? Education : Bachelor's Degree required. Licensure : N/A Knowledge, Skills & Abilities: Three to Five (3-5) years of progressively responsible professional reimbursement experience. Three (3) years of provider relations and/or contracting experience preferred Two to four (2-4) years healthcare payor (including managed care) experience 2+ years of multi-state provider reimbursement experience preferred Experience and comfort with financial model and detailed data analysis What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD #LI-7CF1 PM16 PI116115584

Beacon Health Options Job Category: Provider & Network - General Req #: DIREC01901 Schedule: Full Time Location: CA - Cypress We Help People Live their Lives to the Fullest Potential! For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise. Do you have a passion for helping others? If so, we are looking for you! Beacon is currently seeking a Director, Provider Reimbursement a highly organized and compassionate professional to join our team. The Director of Provider Reimbursement is a highly visible team lead among internal and external stakeholders. The Director of Provider Reimbursement leads a team of analysts that identify, define and update provider facility and professional fee schedules. This role also supports Beacon's provider reimbursement strategies as set forth by Market and Regional leadership, leveraging the organization's matrix structure to engage and coordinate support cross-functionally among key stakeholders. The Director of Provider Reimbursement is develops and maintains the behavioral health reimbursement methodologies for existing, as well as new markets for facilities and professionals. What does a typical day look like? Lead the development/updating and facilitation of the annual loading of benchmark facility and professional fee schedules (Medicare, Medicaid, and Beacon Proprietary) in conjunction with each Region's provider strategy.Serve as the Enterprise subject matter expert regarding reimbursement, fee schedules and rates for new client implementations and upsells for existing clients. Drive implementation activities related to reimbursement.Train and mentor team resources to build core reimbursement knowledge and promote analytical standards and best practices.Lead the implementation of cycle as well as off cycle code additions/deletions to benchmark fee schedule and update existing Beacon fee schedules for cross-walked codes.Facilitate/direct analytical resources to determine the financial impact of updated professional fee schedules for both risk and ASO business.Secure the appropriate grouping/pricing software necessary to support facility contracting for all lines of business in all Divisions/Regions.Lead the development and maintenance of desktop modeling tools for professional rate increases.Develop/utilize reporting tools to index facility rates by level of care and place of service as a percent of benchmark reimbursement levels.Support and participate in the Network Strategy department's process improvement and transformational initiatives to drive completion and successful outcomes.Develop strong provider and Regional relationships built on trust and collaboration. Manage and balance Beacon and provider expectations.Act as liaison and maintain productive working relationships with all Beacon departments.Other duties as assigned. What you Contribute? Education : Bachelor's Degree required. Licensure : N/A Knowledge, Skills & Abilities: Five - Seven (5-7) years of progressively responsible professional experience, with at least three (3) of those years with a provider-facing role Three (3) years of provider relations and/or reimbursement experience Three-five (3-5) years healthcare payor (including managed care) experience preferred 2+ years of multi-state provider management experience preferred Experience and comfort with financial model and detailed data analysis What Makes Us Different? Here, it's not just a job - it's an opportunity to change lives. Our employees are learners, innovators and original thinkers. Our mission and values guide the way we treat our members, providers and each other. What We Have to Offer: Healthcare benefits available starting day 1! Health & wellbeing incentives, such as gym membership reimbursement 401K with company match to help reach your future financial goals Generous PTO, because we know life happens outside of work Tuition reimbursement so you can keep reaching your fullest potential If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started! Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD #LI-7CF1 PM16 PI116115600

The Business Director is responsible for all accounting, human resources, and business office activity (accounts receivable, accounts payable, rent roll, and payroll) for the community in conjunction with the Executive Director and our corporate accounting team. Sagora Senior Living is one of the top 50 senior housing operators in the United States offering independent living, assisted living, and memory care services. We are looking for compassionate and caring individuals to join our team to uphold our "Residents First" philosophy. We offer a competitive compensation and benefits package along with additional company perks. If you are looking for a rewarding position and a great company culture, we urge you to apply! Position details: Community address: 17935 Longenbaugh Dr City, State: Cypress TX Status: Full Time Shift/hours: Monday - Friday 8a-5p with rotating weekends as Manager on Duty Responsibilities: AP and AR for the community Maintaining associate files and assisting with new hire paperwork Generate resident statements and maintain accounts Generate payroll semi-monthly and maintain PTO records for all associates Operate department within budget Assist management team including Executive Director and Home Office staff Perform administrative functions in support of the Executive Director Address resident concerns in regards to bills and accounts Supervise front desk staff Serve as Manager on Duty as assigned Work with management and department heads to market and manage the community Skills/Requirements: Strong AP/AR and payroll experience required Experience in HR duties and associate benefits preferred 1-2 years experience in bookkeeping or office manager/coordinator position Property Management software a plus but not a requirement Strong computer skills including Microsoft Office (Outlook, Excel, Word, PowerPoint) Must be able to read, write and speak the English language and be able to communicate effectively with residents, families, and other staff members Sagora does not accept unsolicited resumes from headhunters, recruitment agencies or fee based recruitment services. Sagora is an equal opportunity employer and will consider all applicants without regard to race, marital status, sex, age, color, religion, national origin, veteran status, disability or any other characteristic protected by law. PM18 PI116074723

Beacon Health Options Job Category: Clinical - Care Mgmt Req #: CLINI01800 Schedule: Full Time Location: CA - Cypress About the Position: Beacon Health Options is seeking a Clinical Care Coordinator to join our Outpatient Clinical Support team in Cypress, CA! The Clinical Care Coordinator is the front line interface to Members and Providers who seek information about behavioral health benefits. The Clinical Care Coordinator assist callers by providing benefit and eligibility information and referrals to network providers, transfers clinical calls to clinicians, and completing specified assignments that assist the department in meeting contractual and or performance goals. Position Responsibilities: Responds to questions about eligibility, benefits and procedures for accessing behavioral health services. Verifies member benefits and eligibility through health plan computer access, phone, and e-mail. Educates callers about Beacon/BCBHM services and their mental health benefits. Obtains urgent, routine with assistance appointments within established time frame guidelines. Verifies that member attends urgent scheduled appointment and reports outcome back to Case Manager. Requests for Single Case Agreement for non-contracted providers per established guidelines. Follows health plan specific contract guidelines. Processes and completes Pre-Review Screenings per guidelines. Coordinates with Case Manager when appropriate in understanding members' needs. Checks voice mail and return calls within 1 business day. Checks e-mail to stay informed of procedures and communicate with team members. Works with health plan, County entities, community agencies and providers to effectively coordinates member care. Provides resources and referrals to members. Consistently provides members, providers, and internal staff with exceptional customer service. Utilizes Pre-Review Screening tool, makes appropriate provider referrals and/or refers to licensed clinician for clinical evaluation. Identifies complaints and assist patients to exercise grievance rights. Identifies calls requiring clinical evaluation or interpretation and refer to licensed clinician. Accesses to Protected Health Information, Beacon/BCBHM and Health Plan Patient Files (ledger, authorizations, and administrative, claims, and clinical notes) as needed for Referral and Authorization; Provider files as needed for Referral and Authorization. Interacts with providers and payers to coordinate patient care and resolve authorization issues. Interacts with clinical CM's, claims, IP and provider relations departments in order to service callers appropriately and process reports. Adheres to all Beacon policies and procedures and standards of operations. Completes all required and assigned trainings. Attend all mandatory company or department meetings. Report to each scheduled shift and commence work and perform essential job function at the start of each schedule shift. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment. Performs special projects and other duties as assigned and required. Position Requirements: Education: High School diploma or GED required, Bachelor's degree preferred Relevant Work Experience: 2-3 years' experience in an administrative support, customer service or similar position required To Apply: Click below on " Apply for this Position " to create a profile and apply for the position Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PI115843080

Beacon Health Options Job Category: Clinical - General Req #: ABACL01801 Schedule: Full Time Location: CA - Cypress About the Position: We are currently seeking a dynamic ABA Clinical Services Assistant II to join our Utilization Management team in Cypress, CA! The ABA Clinical Care Services Assistant II serves as central point of contact and communication for members, families, providers, insurers and members of the ABA team in the linkage of care for Applied Behavioral Analysis (ABA) services. Addresses a broad spectrum of needs and/or concerns in a professional, friendly, and efficient manner. Performs a variety of customer service and unit-operations activities to assist clinical and administrative staff to meet operational and business performance metrics. Position Responsibilities: Assist members and providers with all levels of inquiries, problem solving, insurance information and general customer service, which could include: Customer material requests and member registration Benefit and Eligibility information Physician assignments Authorization for treatment Billing and Payment issues Explanation of Benefits (EOB)/Explanation of Payments (EOP) Clinical Care Management system usage Staff all Call Center queues and adhere to performance requirements for call center response times, abandonment rates, and other productivity, schedule, and quality standards or metrics that may be established. Receive, respond and resolve questions about accessing ABA services. Analyze data and identify appropriate level of care to expedite linkage to care to ABA services. Gather required clinical and financial information care for members and enter data into clinical care management system. Monitor the data in the clinical care management system, collaborating with provider community; escalate issues and concerns regarding care management to Senior Care Managers according to policies and procedures. Act as a liaison with parents and the health community to ensure continuum of care and support for members. Participates in corporate quality improvement functions. Assists with special projects and administrative tasks as assigned. Performs other duties as required. Position Requirements: Education: High School diploma or GED equivalent required Relevant Work Experience: 5 years' general working experience with 2 years' of Customer Services experience required Knowledge, Skills, & Abilities: Previous experience in a call center environment within the healthcare preferred Knowledge or ability to learn state and federal laws and regulations applicable to the call center required Strong analytical, problem solving and organizational skills required Strong interpersonal skills needed to frequently interact with members, families, providers and insurance representatives required General knowledge of clinical documentation, preferably electronic health records/medical records systems preferred Ability to learn, master, and incorporate use of variety of clinical and administrative automated systems and software into daily work required Bilingual in English and Spanish preferred To Apply: Click below on " Apply for this Position " to create a profile and apply for the position Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. #CB #GD PM16 PI115608109