Health Care Program Support Analyst
California Department of Managed Health Care, California, MO, United States
Job Title
Health Care Program Support Analyst (Analyst I)
Job Description
The DMHC Help Center educates members about their health care rights and resolves complaints. The Analyst I, under the supervision of the Supervisor I of the Health Care Program Support (HCPS) in the Call Center, is responsible for screening, analyzing, and triaging Independent Medical Review Applications and incoming consumer complaints. This includes interpreting the Knox‑Keene Health Care Service Plan Act of 1975 (KKA), Title 28 of the California Code of Regulations (CCR), consumer/enrollee contracts, evidence of coverage, and program policies and procedures. Complaints may involve authorization, denial or modification of health services, enrollment or cancellation complaints, continuity of care, quality of care, adequacy of provider networks, access to care, and cost‑sharing fee disputes.
Responsibilities
Screen, analyze, and triage Independent Medical Review Applications and consumer complaints.
Interpret and apply KKA and CCR regulations, consumer contracts, and program policies.
Resolve issues related to authorization, denial, or modification of health care services.
Assist consumers with enrollment or cancellation complaints, continuity of care, and quality of care concerns.
Evaluate provider network adequacy, access to care, and cost‑sharing fee disputes.
Qualifications
Minimum: Analyst I classification, essential knowledge of KKA, CCR, and health plan regulation.
Desirable skills:
Excellent attendance and dependability.
Knowledge of public health, mental health, and health care services programs.
Strong written and verbal communication skills.
Research, analysis, and problem‑solving ability.
Initiative, independence, flexibility, and adaptability to shifting priorities.
Good organizational and multitasking skills.
Working Conditions
Work occurs in a climate‑controlled cubicle or office in Downtown Sacramento or Rancho Cordova. The position may be eligible for hybrid telework with requirements of California residency and compliance with the State Telework Policy.
Benefits
Benefit information can be found on the CalHR website and the CalPERS website.
Equal Opportunity
The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability, family care, gender, military status, national origin, race, religion, sexual orientation, and more.
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Health Care Program Support Analyst (Analyst I)
Job Description
The DMHC Help Center educates members about their health care rights and resolves complaints. The Analyst I, under the supervision of the Supervisor I of the Health Care Program Support (HCPS) in the Call Center, is responsible for screening, analyzing, and triaging Independent Medical Review Applications and incoming consumer complaints. This includes interpreting the Knox‑Keene Health Care Service Plan Act of 1975 (KKA), Title 28 of the California Code of Regulations (CCR), consumer/enrollee contracts, evidence of coverage, and program policies and procedures. Complaints may involve authorization, denial or modification of health services, enrollment or cancellation complaints, continuity of care, quality of care, adequacy of provider networks, access to care, and cost‑sharing fee disputes.
Responsibilities
Screen, analyze, and triage Independent Medical Review Applications and consumer complaints.
Interpret and apply KKA and CCR regulations, consumer contracts, and program policies.
Resolve issues related to authorization, denial, or modification of health care services.
Assist consumers with enrollment or cancellation complaints, continuity of care, and quality of care concerns.
Evaluate provider network adequacy, access to care, and cost‑sharing fee disputes.
Qualifications
Minimum: Analyst I classification, essential knowledge of KKA, CCR, and health plan regulation.
Desirable skills:
Excellent attendance and dependability.
Knowledge of public health, mental health, and health care services programs.
Strong written and verbal communication skills.
Research, analysis, and problem‑solving ability.
Initiative, independence, flexibility, and adaptability to shifting priorities.
Good organizational and multitasking skills.
Working Conditions
Work occurs in a climate‑controlled cubicle or office in Downtown Sacramento or Rancho Cordova. The position may be eligible for hybrid telework with requirements of California residency and compliance with the State Telework Policy.
Benefits
Benefit information can be found on the CalHR website and the CalPERS website.
Equal Opportunity
The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability, family care, gender, military status, national origin, race, religion, sexual orientation, and more.
#J-18808-Ljbffr