15 jobs found in cypress

Beacon Health Options Job Category: Clinical - General Req #: CLINI01623 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 Clinical Services Assistant a highly organized and compassionate professional to join our team at our Cypress, CA. The Clinical Services Assistant provides and participates in a broad range of office support activities for Beacon staff and management. Schedule:8:30 am - 5:00 pm; Monday - Thursday; 9:00 am-5:30 pm; Friday What does a typical day look like? Develops and maintains varied tracking reports related to assigned duties.Interfaces with clients, providers and provider office staff to answer questions and provide benefit information.Supports benefit verification and updates eligibility information as needed.Completes inpatient authorizations based upon structured clinical algorithm and forwards to provider's office.Completes inpatient authorizations following review by clinical staff and forwards to provider's office.Creates new patient files for open cases.Directs callers to appropriate clinical staff.Creates and stores hard copy file for UM staff.Submits admission, discharge and Ambulatory Follow up information to health plans electronically.Meets all regulatory, client, and accreditation organization Turn Around Time (TAT) standardsAttends monthly staff meetings.Trains new staff.Prepares outgoing faxes and mail daily.Photocopies requested materials and keeps copiers, printers and fax machines cleared.Documents receipt of time sensitive materials in the Raintree, FlexCare, and Connects systems.Participates in monitoring department office supplies.Ensures filing is completed on a daily basis.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 commences work and performs essential job functions at the start of each scheduled 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. What you Contribute? Education : High School diploma or GED required. Associates degree or higher preferred. Licensure : N/A Knowledge, Skills & Abilities: Two (2) years secretarial or general office experience. Experience in the healthcare and/or insurance industry and an understanding of behavioral health is plus. Strong interpersonal skills and good written and verbal communication skills. Proficient 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 PI117369488

Beacon Health Options Job Category: Operations - Customer Service General Req #: CUSTO02094 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 8:30 am - 5:00pm (schedule may vary or subject to change) 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 PI117348107

Beacon Health Options Job Category: Operations - Customer Service General Req #: CUSTO02098 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 - 6:00pm (schedule may vary or subject to change) 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 PI117348122

Location: Cypress, Texas, 21212, United States Job ID: 52902367 Posted: 2020-01-21 Position Title: Gastroenterologist Physician Assistant Company Name: Gastro Doxs PLLC Sector: Gastroenterology - PA Entry Level: NO Job Duration: Indefinite Min Experience: 0-1 Year Job Description: Gastroenterologist in Houston looking for Physician Assistant to provide care in both Outpatient and In-patient settings. A typical day would involve hospital consult/ follow and patient visits in the office. Looking for candidates who are ready to start immediately. Description about the practice: Bharat Pothuri, MD, FACG, has dedicated his professional life to helping people in and around the Greater Houston area find relief from a wide range of gastrointestinal conditions. A longtime Houston resident, Dr. Pothuri founded GastroDoxs to provide comprehensive digestive care services in a community that he is proud to call home. PI117326584

Beacon Health Options Job Category: Clinical - General Req #: CLINI02129 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 Clinical Services Assistant a highly organized and compassionate professional to join our team at our Cypress, CA. The Clinical Services Assistant provides and participates in a broad range of office support activities for Beacon staff and management. Schedule:8:30 am - 5:00 pm; Monday - Thursday; 9:00 am-5:30 pm; Friday (32 Hours/week) What does a typical day look like? Develops and maintains varied tracking reports related to assigned duties.Interfaces with clients, providers and provider office staff to answer questions and provide benefit information.Supports benefit verification and updates eligibility information as needed.Completes inpatient authorizations based upon structured clinical algorithm and forwards to provider's office.Completes inpatient authorizations following review by clinical staff and forwards to provider's office.Creates new patient files for open cases.Directs callers to appropriate clinical staff.Creates and stores hard copy file for UM staff.Submits admission, discharge and Ambulatory Follow up information to health plans electronically.Meets all regulatory, client, and accreditation organization Turn Around Time (TAT) standardsAttends monthly staff meetings.Trains new staff.Prepares outgoing faxes and mail daily.Photocopies requested materials and keeps copiers, printers and fax machines cleared.Documents receipt of time sensitive materials in the Raintree, FlexCare, and Connects systems.Participates in monitoring department office supplies.Ensures filing is completed on a daily basis.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 commences work and performs essential job functions at the start of each scheduled 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. What you Contribute? Education : High School diploma or GED required. Associates degree or higher preferred. Licensure : N/A Knowledge, Skills & Abilities: Two (2) years secretarial or general office experience. Experience in the healthcare and/or insurance industry and an understanding of behavioral health is plus. Strong interpersonal skills and good written and verbal communication skills. Proficient 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 PI117321226

Beacon Health Options Job Category: Operations - Claims Audit Req #: ACCRE02152 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 an Accreditation Reporting Specialist a highly organized and compassionate professional to join our team at our Cypress, CA office. The Accreditation Reporting Specialist will be responsible for the planning, coordination, collection and reporting of accreditation data and outreach activities. Provides expertise in business requirements for HEDIS data reporting and analysis. The Accreditation Reporting Specialist will work with Plan staff to evaluate workflows and processes and help build capacity for improvement activities and help the Plan reach incremental and transformative improvement goals. What does a typical day look like? Review and submit accurate data relating to HEDIS and other Quality reports.Responsible for data management and reporting on Quality Improvement Activities (QIAs) and Quality Improvement projects (QIP) for NCQA and URAC accreditations.Remain updated on NCQA HEDIS Technical Specifications.Identify and share best practices throughout the region and organization.Support the development and dissemination of accreditation relevant QI project materials, communications, service excellence, etc. as needed.Stay abreast of new developments and industry trends related to best practices quality metrics, service excellence, practice transformation, and HEDIS interventions.Work with quality team and health plan staff to prepare customized work plans for each health plan / client based on root cause analysis and gaps identified during assessment.Identify challenges and barriers that may prevent health plans / clients from achieving goal in desired timeframe and develop improvement plan with Director of Performance Measurement and Improvement.Analyze data and look at trends regarding performance to develop improvement plans and identify opportunities for shared learning and recognizing best practices.Provide training to staff on HEDIS metrics and interventions.Prepare and submit project status reports to management as often as required.Serve as team member for activities focused on performance improvement.Liaison with Corporate Accreditation team to ensure all accreditation reporting requirements are met.Develop and maintain working relationships with internal and external customers.Prioritize and complete assigned projects timely.Performs other duties as assigned. What you Contribute? Education : High School Diploma required. Bachelor's Degree preferred. Licensure : n/a Knowledge, Skills & Abilities: Minimum 1 year related work experience with some familiarity with NCQA HEDIS Health Plan reporting requirements. Proficiency in current versions of Windows, MS Word, MS Excel or similar spreadsheet packages. Strong interpersonal skills and good written and verbal communication skills. 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 PI117321272

Beacon Health Options Job Category: Clinical - Care Mgmt Req #: UMCAR02133 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! 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 can be a remote / work at home job opportunity for applicants residing and licensed in the state of California* 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. 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 PI117179273

Beacon Health Options Job Category: Clinical - Care Mgmt Req #: UMCAR02133 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! 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 can be a remote / work at home job opportunity for applicants residing and licensed in the state of California* 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. 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 PI117170398

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 PI116732416

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 PI116732418

Beacon Health Options Job Category: Operations - Customer Service General Req #: REPII02030 Schedule: Full Time Location: CA - Cypress ABOUT THE POSITION We are currently seeking a dynamic Sr. Customer Service Representative to join our team at our office in Cypress, CA. The Sr. Customer Service Representative is responsible for all aspects of servicing a member or provider. This position requires a mastery of the CSR I and CSR II capabilities. The incumbent's responsibilities include providing accurate and thorough interpretation of benefits, eligibility, claims payment and interpretation, providing accurate technical information, resolving complex customer inquiries, facilitating problem resolution, and acting as a member/provider advocate by meeting or exceeding customers' expectations. The Senior 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. This position is trained on all Beacon functions/plans and can be utilized in any geographical call center. This is a fully cross trained position within the call center. Position Responsibilities: 1. Provide timely, accurate, and courteous responses to a high volume of telephone inquiries from both members and providers. 2. 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. 3. Maintain adherence to schedule enabling the team to meet client satisfaction levels. Adherence to work schedule including time spent on break/lunch. 4. Achieve and maintain productivity and quality performance expectations; minimum 95% 5. Interpret and effectively communicate benefits and eligibility and claims payment information to our customers. 6. Document all critical information related to contacts responded to in the appropriate in house healthcare systems 7. Demonstrate professionalism, empathy and a sense of urgency on each and every member and provider call/transaction 8. Effectively navigate through multiple complex systems/screens. 9. Have the knowledge around handling escalated calls 10. Provide 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. 11. Keep abreast of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions and department meetings as necessary. 12. Complete daily assigned tasks by management such as website inquiries, COB coordination of benefit updates, and authorization for disclosure forms, authorization updates, and correspondence. 13. Perform additional duties and/or work additional hours as needed. Overtime and working holidays may be required based on business needs. 14. Comply with all the HIPAA Compliance regulations. 15. Interpret and effectively communicate benefits, eligibility, claim payment information, web inquiries and inventory projects assigned by management to our customers. 16. Effectively handle complex correspondence. 17. Lead by example and exhibit role model behavior. 18. Identify CSR training needs by acting as a subject matter expert and mentor for less experienced staff. 19. Identify opportunities for process improvement, and offers problem resolutions. 20. Assist in the handling and resolution of complex and/or escalated telephone inquiries in a timely and accurate manner in order to meet or exceed quality and productivity standards. 21. Achieve and maintain high-level productivity and quality performance expectations. 22. Meet work plan goals; AHT under 8 minutes, Adherence 85%, QA average 97%, Compliance with Relias trainings 99% 23. Sustain minimum of 3 months free of corrective action. 24. Take part in the mentoring of new/current employees 25. Be able to support back office processes 26. Recommend and implement a minimum of two process improvements for customer service Position Requirements: Minimum Entry Level Qualifications: Must possess the ability to function in an interdisciplinary setting. Must have knowledge and experience using management information systems. Strong customer Service orientation and excellent written and verbal communication skills required. Must be knowledgeable about care resources and levels of care availability. Education: A high school/GED diploma is required. An Associate's or BS Degree or equivalent, related experience is strongly preferred. Licensures: n/a Relevant Work Experience: 3 years in Customer Service, Health Care or Health Insurance is required. Strong verbal/written communication skills, typing skills and strong problem solving skills are also required. Previous experience in an ACD call center environment is preferred. Demonstrated call center skills and ability to handle difficult call situations- diffusing situations 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 PI116732359

Beacon Health Options Job Category: Clinical - Quality Mgmt Req #: DIREC01998 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 Quality Ops a highly organized and compassionate professional to join our team at our Cypress, CA. Functions as an integral part of the Clinical leadership team. Works collaboratively with the Clinical leadership team to implement new business, enhance clinical programs, clinical operations and other strategic initiatives. Analyzes key performance indicators, current policies and procedures and creates action plans to support compliance with client expectations, accreditation standards, regulations and strategic clinical goals. What does a typical day look like? Develops workflows, policies and procedures for provision of utilization management and care coordination activities.Manages clinical implementation of new business, enhancement of clinical programs, clinical operations and other strategic initiatives.Serves as project manager on clinical initiatives; defines project plan and deadlines and ensures appropriate engagement of downstream operational areas to clinical initiatives such as network, configuration, provider relations etc.Tracks and prioritizes clinical projects in collaboration with the VP, Clinical Services. Intakes and triages new operational issues and facilitates next steps to ensure effective policies and procedures are in place.Provides oversight of clinical operational activities; ensures clinical policies and procedures are appropriately updated, approved and operationalized internally; makes recommendations to senior leadership on clinical policies.Represents Clinical leadership at internal and external meetings on clinical issuesWorks with reporting to develop accurate and adequate data to effectively manage utilization and identifies targeted opportunities to improve performance; responsible for overseeing reporting of accurate data assigned to operational team.In collaboration with the Clinical Leadership Team, utilizes data to evaluate current programming and to develop and implement new initiatives that address clinical operations goals.Develops collegial relationships at local and corporate level as well as within the provider community, community agencies and the state to assure effective, efficient and coordinated utilization and case management activities.Collaborates with VP Clinical services as well as the regional financial officers regarding administrative budget and medical cost ratio.Monitors Clinical PG's and KPIs, CAPs in collaboration with Clinical and Regional Leadership team.In collaboration with the clinical leadership team supports audit process, including readiness review, file preparation/submission and policy review.Oversee development and regional clinical training program.Works with clinical teams to develop reporting necessary to monitor performance.Develops and assist with updates to Program Descriptions, Program Evaluations and work plans.Other duties as assigned What you Contribute? Education : A minimum of a Master's Degree in a related field (Business Administration, Healthcare Administration, behavioral sciences etc.); Post Graduate Degree in healthcare field; RNs will also be considered. Licensure : Licensed behavioral health clinician/nurse (LCSW, LMFT, LPCC, RN, Ph.D. or PsyD.) Who has Certification as a Care Manager is preferred. Current, valid and unrestricted clinical licensure required with proof upon hire. Knowledge, Skills & Abilities: Minimum of 5 years managed health care experience. Preference will be given to candidates who have worked within a managed care health plan setting. Senior-level experience with operations and UM; fluency in clinical operations and driving operational efficiencies; and understanding of regulatory and accreditation requirements necessary. Strong interpersonal skills and good written and verbal communication skills. Proficient 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 #LI-7CF1 PM16 PI116732361

Beacon Health Options Job Category: Clinical - Care Mgmt Req #: CAREM01895 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 Care Manager a highly organized and compassionate professional to join our team at our Cypress, CA / Los Angeles area. The Care Manager is the health professional who coordinates integrated, seamless and person-centered service in support of members under Medicare and MediCal programs. The Care Manager will coordinate amongst all Interdisciplinary Care Team (ICT) members to develop the Individualized Care Plan (ICP) and oversee ICP implementation. S/he is available to the health plan and community based Case Management provider agencies for consultation when issues with regards to behavioral health management or treatment arise. What does a typical day look like? Responsible for maintaining accurate information in Beacon's clinical documentation systems. Identifies, assesses, and holistically manages complex behavioral health cases for assigned members. Provides individualized person-centered support to members. Provides health coaching and wellness education to members as appropriate. Develops or oversees the ICP for each member in collaboration with all team members (i.e. Primary Care Providers, Behavioral Health Providers, and Health Plan Case Managers), adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes. Utilizes the evidence based guides to identify problem areas; 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. Performs special projects and other duties as assigned and required. What you Contribute? Education : Either Master's level in a behavioral health discipline: social work, counseling, psychology or ADN or higher Licensure : Unrestricted CA clinical license (LCSW, LPCC, LMFT, RN, PsyD, or PhD) Minimum 3 years Behavioral Health or Community Services required Call Center, Customer Service experience a plus Knowledge, Skills & Abilities: Knowledge of managed care and state specific expertise preferred. Demonstrated experience exercising influence and negotiation skills to effectively manage patient care and health care outcomes. Demonstrated experience meeting strict deadlines and established cycle times through effective prioritization and follow-up. Strong interpersonal skills and good written and verbal communication skills. Proficient 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 #LI-7CF1 PM16 PI116732381

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 PI116732292

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 PI116732324