Implementation Consultant – Community Support (Claims)

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Medasource

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Position Title: Implementation Consultant – Community Support (Claims)

Contract Length: EOY 2024

Start date: ASAP

Location: Los Angeles Greater Area (Pasadena on-site once per week preferred)

 

Overview: This role will support our client's Medi-Cal expansion and compliance with DHCS requirements.

 

Responsibilities:

  • Acclimating members to the Medi-Cal model
  • Handling operationalization and implementation mutually to work cohesively
  • Communicating between the Claims team and the Medi-Cal team
  • Working with referrals, authorizations, and HCPCS codes
  • Managing external and internal stakeholders effectively

 

Required Experience:

  • 5-10 years of Claims experience with a Health Plan or Planned Partner
  • Experience working between Health Plans and Community-Base Organizations, risk modeling, social determinants
  • Experience in Community Supports and other CalAIM initiatives
  • Program Management experience in community health
  • Bachelors Degree or higher education
  • Ability to communicate between multiple, diverse stakeholders
  • Someone who is enthusiastic and ready to hit the ground running
  • Tenacity – passion, drive, and commitment to the positive outcomes

Preferred:

  • Experience managing highly complex projects/programs with multiple stakeholders
  • Experience with Claims support
  • Experience with UM functions such as authorizations, denials, notice of action letters
  • Member center design skillset
  • Master's Degree or equivalent work experience

Medasource provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, national origin, age, sex, citizenship, disability, genetic information, gender, sexual orientation, gender identity, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state, and local laws.

JO-2402-143065

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