San Diego Pediatrics Careers | Children's Physicians Medical Group
MENU
Careers.BUILDING THE RIGHT TEAM.

Children’s Physicians Medical Group (CPMG) is a pediatric-only Independent Physicians Association (IPA), associated with Rady Children’s Hospital – San Diego. Its provider network includes 196 primary care pediatricians and 240 pediatric subspecialists. These providers in conjunction with Rady Children’s Hospital have formed an Integrated Delivery System (IDS) known as Rady Children’s Health Network (RCHN). Currently, 75,000 children are enrolled in CPMG through eight managed care Health Plan contracts and one Medi-Cal contract. Additionally, CPMG and its network partners provide MSO services to 400,000 other patients and their providers in San Diego, Southern Riverside, and Orange County.


Current Openings:

TO BE CONSIDERED FOR ANY OF THE FOLLOWING OPPORTUNITIES YOU MUST SUBMIT A LETTER OF INTEREST AND RESUME TO HUMAN RESOURCES AT cpmghr@rchsd.org.

Brief job description:

This position acts as a key liaison between CPMG’s primary care physician network, ancillary providers, health plans, and other partner organizations. The Provider Relations Representative is responsible for the development and maintenance of positive working relationships with all partners, by collaborating on complex organizational initiatives across the integrated delivery system.

•Works directly with senior management to create and implement policies/procedures for network of contracted providers in order to further CPMG’s strategic plan.
•Primarily responsible for education of contracted offices, including physicians, administrators and billing staff, on CPMG/RCHN initiatives, serving as a liaison to CPMG administration.
•Receive, research, and respond to unique, complex inquiries from providers and senior leadership with minimal supervision.
•Manage provider related issues, grievances and concerns of a complex nature, with a high level of professionalism.
•Prepare presentations for committee and/or board meetings relative to Provider Relations initiatives.
•Acts as a subject matter expert (SME) on the operations of CPMG’s network of providers, including office performance, structure, and nuances.
•Initiates corrective action plans for contracted providers, including contract and legal review when appropriate.

Minimum job qualifications (education, experience, certification, skills, etc):

•Three (3) years direct experience in managed care, with working knowledge of IPA/Medical Group, health plan / HMO operations, physician office management, or an equivalent combination of education and related experience
•High school degree or equivalent education/Bachelor’s degree preferred.


Brief job description:

The Administrative Specialist will provide administrative support regarding operational aspects of Utilization Management requirements. Tasks shall include extensive computer work in Excel, Word, Outlook, PowerPoint and data entry in other software systems. Will be working primarily with the Associate Director, Member Services & UM Operations, but will also assist with projects or activities of related departments, including Quality Improvement, Provider Relations, and Customer Service. The UM Administrative Specialist is expected to have strong computer skills, the ability to communicate in a collaborative and efficient manner, and the ability to effectively prioritize projects and work independently.

Essential Responsibilities:

  • Maintains all Utilization Management letter templates, based on health plan requirements, including letter templates for multiple health plans, in multiple languages, which are strictly monitored by regulatory agencies.
  • Responds to health plan correspondence and coordinates production of reports or requests for data in response to health plan requests.
  • Demonstrates strong professional communication skills while communicating with internal and external customers, including health plan oversight agents, clinical staff, and other health care professionals.
  • Compiles data and independently composes reports and correspondence involving an understanding of operating unit programs, policies, and procedures.
  • Responsible for appropriate tracking, processing, and response to all Grievances and Appeals. Includes communication with health plan representatives, provider offices, and internal clinical staff in an organized and collaborative manner.
  • Performs special projects on a regular basis for a variety of departments and leaders. Must be able to ascertain when various projects would take priority.
  • Assists with organizing and preparing for health plan regulatory audits of Utilization Management processes. Includes review and preparation of audit materials in conjunction with the Associate Director, Member Services & UM Operations, and the Director, Network Operations.
  • Assists with committee meetings, including preparation of committee meeting materials, compiling meeting agendas, printing of materials, and preparation of meeting minutes.
  • Performs related duties as assigned.

Minimum job qualifications: 

  • Minimum of three (3) years of administrative support experience. Administrative healthcare experience a plus.
  • High School or equivalent required. Some college preferred.