Job Overview:

We are currently seeking a qualified candidate to work as a Director of Quality Improvement and Performance in a health plan setting. This is a permanent, direct hire position.

Job Responsibilities:

- Develop policies and procedures and coordinate to develop systems which enable efficient and successful Quality Improvement and Value Performance programs.
- Develop goals, measures, and reporting of network performance against internal and external benchmarks.
- Identify, obtain, and manage appropriate resources, including staff, necessary to achieve system performance goals.
- Establish special projects as needed.

Job Qualifications:

- Minimum of five (5) years healthcare practice or physicians quality management experience.
- Knowledge of the CMS Medicare Advantage Star Program.
- Knowledge of California IHA Pay for Performance (or Pay for Value) program or the HEDIS based quality measures.
- Three to five (3 - 5) or more years of experience directly supervising staff.
- Demonstrated ability in working with multiple teams and a strong history of establishing collaborative relationships with physicians, other practitioners, and practice site staff.

Discover all that's possible with Yoh. Apply now.

Recruiter: Alexis Henderson

Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading HR Solutions.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

MONJOB

Ref: 1021381

SFSF: HC

Job Overview:

Our client is currently seeking a qualified candidate to work as a Claims Recovery Manager in a health plan office setting. This is a temporary, full-time contract position.

Job Responsibilities:

- Developing and overseeing the processes, policies and procedures, and support staff
- Review and manage programs for claims overpayments, capitation deductions performed by the health plans, reinsurance recoveries, and health plan pay and chase recoveries
- Define specifications and create the reporting necessary to support recovery activities while driving improved financial performance
- Manage 2 claims auditors and finance department administrative staff

Job Qualifications:

- Minimum of five (5) years experience working in a California delegated model claims operation is required
- Minimum of two (2) years as a Claims Manager with at least one direct report required
- Must have expert knowledge of medical claims processing procedures, medical claims data, and healthcare coding conventions such as ICD-9, CPT, and HCPCS
- Strong data manipulation skills including extensive experience working with MS Excel, MS Access, and other database platforms

Preferred Job Skills / Experience / Education:

- Bachelor's Degree is preferred

Discover all that's possible with Yoh. Apply now.

Recruiter: Alexis Henderson

Yoh is a professional staffing provider with over 70 years of experience in the short and long-term staffing services industry; visit our website to learn more about our company. If you are seeking workforce solutions in the IT sector, see our comprehensive IT Staffing Resources.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

MONJOB

Ref: 1018871

SFSF: HC

Job Responsibilities:

- Enterprise network routing/switching strategy, solutions, and ongoing technology refresh and enhancements
- Enterprise network routing / switching design standards
- Design reviews and project engineering.
- Acquisition integration for network routing / switching services.
- Technology integration point with other Engineering towers to provide strategic solutions.
- Feasibility engagements with business groups to ensure integrated network strategies are incorporated early in the process.
- Provide Technical leadership and guidance to junior personnel
- Implement engineering designs

Job Qualifications:

- Two (2) Years experience in Technical Leadership of medium to large IT projects
- Five (5) Years experience in all technical aspects of Routing / Switching Engineering
- Four (4) Years experience with Cisco technologies
- One (1) Year experience with Cisco ASR and ISR-G2 technologies
- Experience with GET VPN design and configuration
- Experience with MPLS design and configuration
- Experience with BGP send- communities
- Experience with QOS technologies and VoIP implementations
- Experience with multi-VRF terminations
- Experience with Campus network design
- Experience with OPNET tools and Wire shark analysis

Discover all that's possible with Yoh. Apply now.

Recruiter: Greg Damiano

Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading HR Solutions.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

Tax Term: CON_W2

J2W: INFOTECH; J2W: ENG

Ref: 1021592

Branch: IT & Telecom

Job Overview:

We are currently seeking qualified candidates to work in the capacity of Claims Examiners in a health plan setting. These are full-time, temp-to-hire opportunities.

Job Responsibilities:

- Independently review, adjudicate and finalize Provider Dispute Resolution (PDR) requests.
- Processing claims adjustments requests received from Customer Service.
- Adjudicate special projects claims.
- Research and review necessary documentation and apply claims policy appropriately and accurately in order to resolve and finalize claims adjustment requests.
- Process professional and institutional electronic and paper medical claims.

Job Qualifications:

- High school diploma.
- Three to five (3 - 5) years of prior claims processing experience in an IPA or HMO related setting.
- Prior experience with claims adjustments and PDRs is preferred.
- Knowledge of and working experience with ICD-9, CPT and HCPC coding systems.
- Thorough knowledge of medical terminology, enrollment and membership activities and claim processing procedures / systems.
- Basic understanding of Microsoft Word and Excel applications.

Discover all that's possible with Yoh. Apply now.

Recruiter: Alexis Henderson

Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading professional staffing solutions.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

MONJOB

Ref: 1021608

SFSF: HC

Job Overview:

We are currently seeking a qualified candidate to work as a Pre-Certification RN or LVN in a health plan, work-from-home setting. This is a full-time contract-to-hire position.

Job Responsibilities:

- Utilize evidenced based criteria sets and or health plan criteria to review provider requests for prior authorization of outpatient and inpatient services.
- Conducts prospective and retrospective authorization review for up to 50 cases per day.
- Ensures services authorized are covered benefits and medically necessary.
- Documents medical determinations, citing criteria used to make determinations.
- Forwards potential denials and services requiring physician review to the assigned medical director.

Job Qualifications:

- Valid CA RN or LVN license.
- Strong working knowledge of clinical criteria sets such as CMS local and national guidelines, Milliman criteria, and Interqual criteria.
- Minimum of five (5) years in a medical setting.
- Prior precertification experience required.
- Experience working with health plans, IPAs, physician offices, ancillary vendors and hospitals is required.

Discover all that's possible with Yoh. Apply now.

Recruiter: Alexis Henderson

Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading staffing solutions.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC; J2W: CLINICAL

MONJOB

Ref: 1021930

SFSF: HC

Job Overview:

We are currently seeking a qualified candidate to work as a Utilization Management Coordinator in a health plan office setting. This is a full-time contract position.

Job Responsibilities:

- Analyze, prioritize, and prepare referral and authorization requests.
- Run daily reports to monitor authorizations in pending statuses, hospital inpatient admissions for outlier days, and denials generated.
- Perform accurate verification of eligibility and benefits for authorization requests.
- Accurately review and finalize authorization requests within the Department of Managed Health Care (DMHC) and CMS mandated timeframes.
- Advanced application of CPT, HCPCS and ICD-9 codes.

Job Qualifications:

- Two (2) years of college or equivalent work experience in utilization review or management is required.
- Two (2) or more years of experience in a managed care environment, IPA or Health Plan experience is required.
- Experience in use of various system software as well as Windows, Microsoft Word, Microsoft Excel is required.
- Strong working knowledge of CPT, HCPCS and ICD-9 codes.

Discover all that's possible with Yoh. Apply now.

Recruiter: Alexis Henderson

Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading staffing solutions.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

MONJOB

Ref: 1021929

SFSF: HC

Job Responsibilities:

- Review claims transaction audit reports, perform claims adjudication quality review.
- Perform daily review of pre and post-payment audit reports and daily review of all denied claims.
- Conduct analytical research to effectively resolve processing issues, identify error trends.
- Provide initial claims processing training and contribute qualified data for incorporation into training programs, policies and procedures.

Job Qualifications:

- High School Diploma is required; some college-level education is preferred.
- Seven (7) years of prior claims processing experience in an IPA or HMO related setting.
- Understanding of industry standard claims processing guidelines.
- Knowledge of and working experience with ICD-9, CPT and HCPC coding systems, medical terminology, enrollment and membership activities.
- Prior experience with training is preferred.

Discover all that's possible with Yoh. Apply now.

Recruiter: Alexis Henderson

Yoh is a professional staffing provider with over 70 years of experience in the short- and long-term staffing services industry; visit our website to learn both about our company and about our leading professional staffing solutions.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

MONJOB

Ref: 1021609

SFSF: HC