1. Primary Care Sports Medicine Physician (1 opening)

Schedule: Full – time (4 or 5 days with outpatient call)
        Location: Hawthorne & Slauson (Los Angeles)
        Position Summary:
                        * Outpatient practice including primary care and sports medicine
                        * Interact with physical therapists and orthopedic surgeons in community
                        * Conduct teaching sessions for primary care providers in medical group
        Qualifications:
                        * Completion of primary care residency (family medicine or internal medicine) with additional                           certification in primary sports medicine
                        * Board Certified/Board Eligible
                        * CAQ in sports medicine or eligible to sit for exam
                        * CA license or application for CA license

2. Utilization Management Medical Director (1 opening)

            Supervisor: MSO Medical Director
Schedule: Full-time
Location: Los Angeles (Wilshire Blvd.)
Position Summary: Oversees all utilization management functions for an MSO that manages a medical group with 30 primary care physicians and 20,000 members as well as an IPA with 10,000 members.
Responsibilities:
                * Review of all referral requests which require direct review by MD
                * Retroactive review and adjudication of all referral claims (ER, inpatient, outpatient)
                * Preparation of all denial and deferral letters
                * Response to all appeals (pre-service and retroactive)
                * Develop ongoing policies regarding review process in coordination with MSO Medical                   Director
                * Interface with medical reviewers at individual medical groups (AMG, Affiliates)
                * Coordinate and conduct UMC meetings
                * Attends JOCs with health plans
                * Conduct JOCs with individual group leadership at least twice a year
                * Analyze health plan statistics regarding pharmacy compliance, ER, utilization
                * Give feedback to physicians re their individual UM including specialty referrals, pharmacy,                   ER utilization
                * Potential train and oversee UR Nurse who determines which referrals can be reviewed                   per protocol versus required referral by MD
Qualifications:
                * Board certification in Internal Medicine or Family Medicine
                * Current State of CA license
                * A minimum of five years working in a managed care environment within a risk-bearing                   organization
                * Strong clinical knowledge base
                * In depth understanding of federal and state statutes that regulate managed care medicine
                * Broad understanding of health care industry
                * Ability to effectively communicate
                * Strong organizational skills
                * Ability to set priorities and manage multiple tasks
                * Ability to continue pursuit of evidence-based medicine
                * Interest in continued expansion of clinical knowledge

3. UM/QM Case Manager (2 openings)

            Schedule: Full-time
Location: Los Angeles (Wilshire Blvd.)
Position Summary:
                * Monitor utilization of inpatient stays to determine and ensure that appropriate level and                   quality of care is given to health plan members
                * Participate in initial discharge planning and coordination of that plan
                * Coordinate quality assurance program including obtaining, recording/reporting essential                   data, and assisting in problem-solving
Qualifications:
                * Registered Nurse (RN) or Licensed Vocational Nurse (LVN) License
                * Current State of CA License
                * At least 2 years experience with Acute Care or Ambulatory Case Managing
                * Korean Bilingual
                * HMO experience

4. UM/QM Assistant (1 opening)

            Schedule: Full-time
Location: Los Angeles (Wilshire Blvd.)
Position Summary:
                * Reports to the Director of Managed HealthCare Services and is responsible for                    providing clerical support for all functions in the UM/QM Dept
                * Assist UM/QM Dept. with assigned duties including phone calls to patients and                    providers to resolve grievance
                * Processes patients referral requests to home health providers, arrange                    ambulance or wheelchair transportation
Qualifications:
                * At least one year experience in medical office setting
                * Knowledge of medical terminology & computer experience (Epic, Cerecons, IDX, etc.)
                * Korean Bilingual preferred
                * HMO experience

___________________________________________________________________________________

To apply, please send your CV and cover letter to aileen.zeidman@providence.org or fax it to
(310) 531-2087.

For further inquiries, please contact the HR Department at (310) 531-2115
between 9:00-4:00 pm.

FOR ALL OTHER POSITION OPENINGS, PLEASE GO TO: http://www.providenceiscalling.jobs/index.html