Career Opportunities

How to Apply

  • Online – by Email
    Email your cover letter and resume. Please included your salary requirements to: HealthSmartHR@healthsmartmso.com
  • Letter – by mail
    Mail your resume with work history. Please included your salary requirements to address:
    HealthSmart MSO, Inc.
    Attn: Human Resources P.O. Box 6300 Cypress, CA 90630-6300
  • HealthSmart MSO, Inc. offers an excellent work environment and is looking for long- term team members to continue with our growth.
  • Come Join Our Team!

    We have openings in the following Departments:

    UM REPORTING SPECIALIST
  • This position works under the direction of the VP, Medical Management in support of ensuring reporting and compliance with the Utilization Management and Quality Management Plans and Work Plans.
  • EDUCATION-SKILLS-EXPERIENCE REQUIREMENT:
    • Minimum Medical Assistant level education and/or 5 + years experience in Utilization Management.
    • Strong knowledge of Managed Care principles.
    • Knowledge of UM requirements to include turnaround times on all lines of business, UM processes and the ability to evaluate status of compliance with requirements and implement corrective action where necessary.
    • General ICD-10 & CPT Coding experience.
    • Strong in Microsoft Word & Excel
    • Detail oriented and statistical minded
    • Ability to prioritize and adjust work volume to meet deadlines.
    • Values and works well in a team environment
    DUTIES-RESPONSIBILITIES:
    • Oversees Health Plan UM/CM Reporting
    • Works in conjunction and collaborate with other reporting specialists to ensure timely submissions via FTP sites and other platforms.
    • Preparation, review, and submission of UM reporting for IPA and Health Plans.
    • Utilizes departmental reference tools to ensure submissions are timely, appropriate naming conventions are used and reporting formats/formulas are followed.
    • Collaborate with team members to update departmental reference tools.
    • Analyzes data for trending, opportunities for improvement, compliance concerns and corrective action plan evaluations.
    • Facilitates appropriate work groups for problem solving and interdepartmental solutions when needed.
    • Support in Health Plan Audits & Corrective Action implementation.
    Click here to view the job description
    NURSE, CONCURRENT REVIEW CASE MANAGER
  • To ensure coordination of timely and appropriate care for all hospitalized members; To ensure the delivery of cost-efficient, appropriate health care services for all members; To ensure members with complex and chronic care needs are addressed; To ensure plan for coordination among all disciplines; To ensure that medically necessary care is delivered for members that require extensive on-going service; Identification of any potential quality issues.
  • EDUCATION-SKILLS-EXPERIENCE REQUIREMENT:
    • Licensed Vocational or Registered Nurse with valid California Nursing License.
    • Experience in telephonic concurrent review process.
    • Experience in Case Management in hospital, IPA or managed care environment.
    • Knowledge of medical criteria for length of stay and/or experience with Milliman and/or Interqual Healthcare Guidelines
    • Basic computer data entry experience.
    • Knowledge of CPT/ ICD-10 coding.
    ACCOUNTABILITY-DUTIES-RESPONSIBILITIES:
    • Maintain compliance with UM Plan and Policies and Procedures as related to your role of Nurse, Case Manager
    • Coordinate daily Concurrent Review activity for assigned IPAs/Medical Groups, by coordinating with Hospital Case Managers, Health Plans, Primary Care Physicians, Medical Director, Hospitalists, etc.
    • Identify Estimated Length of Stay and necessity using Apollo, Interqual and/or Milliman Healthcare Guidelines.
    • Ensure review appropriateness (IP criteria met) of admission within 24-hours of notification.
    • Coordinate and ensure timely discharge planning with appropriate contracted ancillary providers.
    • Identify Potential CCS Eligible conditions and coordinate with CCS Coordinator. Assist with obtaining CCS authorization and logging in system.
    • Identify and refer cases for outpatient Case Management using criteria and support activities.
    • Ensure documentation of denial of service. Ensure denial letter is sent within 24 hours of the denial decision.
    Click here to view the job description
    INTAKE COORDINATOR
  • Assist in all case management and concurrent review activities for assigned IPA(s), ensuring timeliness and accuracy. Responsible for opening and maintaining case management files for assigned IPA(s).
  • EDUCATION & EXPERIENCE REQUIREMENTS
    • High School Graduate.
    • Medical Assistant, experience in Managed Care and/or referral processing, preferred.
    • Experience in managed care environment.
    • ICD-9, and ICD-10 coding experience.
    • Organization, Data Entry and Filing Skills.
    ACCOUNTABILITY/DUTIES/RESPONSIBILITIES:
    • Accurate and timely processing of concurrent review referrals for assigned medical group(s), including:
      1. Eligibility verification
      2. Benefit verification against established criteria for inpatient hospitalizations
      3. Review of prior activity
      4. Timely data entry
      5. Ensure coordination of services, where necessary
      6. Ensure timeliness of notification to providers
      7. Maintain accurate detailed notes of activity related to inpatient hospitalizations
    • Responsible for monitoring and delivering of all information received via the Fax, including:
      1. Accurate date stamping
      2. Timely & accurate delivery
      3. Maintenance of Fax machine
    • Responsible for opening and maintaining case management files, including:
      1. Creating new cases in Concurrent Review Module
      2. Checking eligibility and attaching records to the electronic file
      3. Completing Medical Record Request form and faxing to facilities
      4. Maintaining E-Health system indicating open and closed cases
    • Maintain professional interaction with Medical Directors, Physician Reviewers, IPA Physicians and staff/coworkers, etc.
    • Report any delays in obtaining the required records and data entry of authorization to Supervisor.
    • Obtain assistance and direction with difficult authorizations from UM Supervisor or UM Lead.
    • Maintain compliance with HIPAA rules and regulation.
    • Mailing, as required.
    • Other duties, as identified/assigned.
    • Click here to view the job description
    UM COORDINATOR
  • Assist in all UM referral activity for assigned Medical Group(s), ensuring timeliness and accuracy.
  • EDUCATION & EXPERIENCE REQUIREMENTS
    • High School Graduate.
    • Certified Professional in Utilization Management (CPUM) or Certified Professional in Utilization Review (CPUR) or Medical Assistant with 2 years experience in UM.
    • Experience in managed care environment.
    • ICD-10, CPT and referral processing experience.
    • Data Entry Skills.
    ACCOUNTABILITY/DUTIES/RESPONSIBILITIES:
    • Accurate processing of referrals for assigned medical group(s), including:
      1. Eligibility verification
      2. Benefit verification
      3. Review of prior activity
      4. Data entry of timely outcome (approval, denial) and follow up
      5. Ensure coordination of services, where necessary
      6. Ensure timeliness of notification to providers (and members, when indicated)
      7. Maintain accurate detailed notes of activity related to referrals.
    • Timely processing of referrals for assigned medical group(s) according to timeliness chart.
    • Maintain coordination of services between health plans, CCS, Case Management, Linked services, etc.
    • Maintain professional interaction with Medical Directors, Physician Reviewers, IPA Physicians and staff, Nurse/Case Managers for Outpatient coordination of Case Management cases, Fellow coworkers, etc.
    • Report any delays in authorization to UM Supervisor or Lead
    • Obtain assistance and direction with difficult authorizations from UM Supervisor or UM Lead.
    • Maintain and update Matrix logs.
    • Maintain Inter-rater reliability score of 95%. Implement any requests for corrective action immediately.
    • Maintain compliance with HIPAA rules and regulation.
    • Other duties, as identified/assigned.
    • Click here to view the job description
    CUSTOMER SERVICE REPRESENTATIVE
  • We are currently seeking a service-oriented individual with excellent customer service skills to provide assistance to our members and providers via telephone. Must be able, to work in a fast paced call center environment answering member questions, processing and documenting information, and providing follow-up assistance as needed.
  • Experience & Education:
    • High school diploma or equivalent required.
    • Minimum 2 years' experience in a customer/member service or call center capacity.
    • Bilingual skills in English-Spanish and/or English-Korean highly desirable.
    • HMO, Medi-Cal/Medicaid and health services experience preferred.
    Click here to view the job description