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Astiva Health Inc
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  • Contract Coordinator  

    - Kern County
    SUMMARY: The Contract Coordinator is responsible for assisting the Con... Read More
    SUMMARY: The Contract Coordinator is responsible for assisting the Contracting and Legal Department for the coordination and review of all contracts. The Contract Coordinator is also responsible for implementing, organizing, and maintaining contract related documents. This is a collaborative role requiring critical thinking skills, independence, a strategic mindset, and attention to detail. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Manage and maintain Astiva’s contracts, including all day-to-day data entry, permissions/access and reporting, in an efficient, accurate and exceptionally organized manner. Review a wide range of commercial contracts and distill key pieces of data (e.g., expiration date and type, restrictive provisions, and assignability). Understand the contracting process, policies and procedures, requirements, fee schedule, including contracting support for ancillary services contracts, contract implementation and other duties as required. Manage reporting process for communicating and tracking contract expirations/renewals and additional reporting obligations to all areas of the business. Serve as liaison between the Contracting/Legal Department and other departments including, fielding and responding to various requests from the business and external parties. Manage electronic signature processes and contract workflows for the Contracting/Legal Department. Assist in developing the direct network of providers. Make recommendations to department leadership for improvement of any and all procedures and systems at Astiva Health. Other duties may be assigned. QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE : Bachelor’s degree from an accredited college or university with a focus on Business Administration, Healthcare Administration or Finance or equivalent combination of education and experience. Be able to work effectively with all levels of employees and management. Excellent written and verbal communication skills with experience presenting to various audiences. Have a practical, business-oriented approach to problem-solving and be able to effectively work with teams to meet business needs. Able to manage multiple priorities in a fast-paced environment. Preferred but not required Minimum of one (1) year of experience in Medical Group/IPA, Managed Care, and HMO. Minimum of one (1) year of experience in provider network development and/or provider network management capacity, account management, or provider relations experience in a managed care organization. In-depth knowledge of contracting, reimbursement, credentialing, and operations, and must be proficient with MS Office Suite and other database software. Knowledge of Medicare regulations, NCQA, HIPPA compliance BENEFITS: 401(k) Dental Insurance Health Insurance Life Insurance Vision Insurance Paid Time Off Catered lunches Read Less
  • Utilization Management (UM) Manager  

    - Sacramento County
    About Us: Astiva Health, Inc., located in Orange, CA is a premier heal... Read More
    About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: Astiva Health Inc is looking for a highly energetic and collaborative Utilization Management Manager. This role will report to the UM Director. The primary objective of the UM Manager is to foster an environment of excellence in servicing Astiva Health’s members. This includes extensive interaction with client organizations and multiple stakeholders, delivering a high-quality UM operation meeting and exceeding all service level agreements (SLA) and KPIs, driving operational excellence, and building competencies for delivery. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Performing ad hoc UM functional audits and delegation oversight audits. Analyzing data and preparing concise, accurate, and meaningful reports in accordance with UM policies and procedures; defining opportunities for improvement through trend analysis and communicating information appropriately. Ensures SLAs are met and reported monthly. Lead orientation and training for new Utilization Management staff related to managing role/workflow expectations. Perform case reviews of Utilization Management Coordinators evaluating policy/protocol adherence, interdisciplinary team collaboration, and utilization trends of engaged populations. Provide feedback related to productivity and caseload management opportunities. Adhering to company policies and procedures regarding confidentiality and privacy. Providing utilization management services and providing supervision and leadership. Responsible for directly managing the UM team or as defined by the UM Director. Manage each team member of the Utilization Management team through frequent communication, case reviews, performance evaluations, onsite assistance, and as a resource as needs arise. Responsible for promoting the ongoing development of all staff and maintaining a professional environment in which all staff can thrive and develop. Includes ongoing collaboration and communication with providers, clinical staff, case managers, and clients utilizing collaborative decision-making when appropriate. Be responsible for day-to-day interaction and quarterly JOM with client organizations to help run a high-quality UM operation. Regular and consistent attendance Other duties as assigned EDUCATION and/or EXPERIENCE : Registered Nurse with Active unrestricted US Registered Nurse license required Associates or Bachelors Degree required. 3 years direct, clinical nursing experience required. 2 years of Utilization Management or Case Management experience required. 2 year of supervisory, management or team lead experience required. Ability to demonstrate problem-solving, facilitation, and analytical skills. Microsoft Excel, PowerPoint, Outlook, Teams experience. Experience working both independently and, in a team-oriented, collaborative environment. BENEFITS: 401(k) Dental Insurance Health Insurance Life Insurance Vision Insurance Paid Time Off Free catered lunches Read Less
  • Utilization Management (UM) Manager  

    - Alameda County
    About Us: Astiva Health, Inc., located in Orange, CA is a premier heal... Read More
    About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: Astiva Health Inc is looking for a highly energetic and collaborative Utilization Management Manager. This role will report to the UM Director. The primary objective of the UM Manager is to foster an environment of excellence in servicing Astiva Health’s members. This includes extensive interaction with client organizations and multiple stakeholders, delivering a high-quality UM operation meeting and exceeding all service level agreements (SLA) and KPIs, driving operational excellence, and building competencies for delivery. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Performing ad hoc UM functional audits and delegation oversight audits. Analyzing data and preparing concise, accurate, and meaningful reports in accordance with UM policies and procedures; defining opportunities for improvement through trend analysis and communicating information appropriately. Ensures SLAs are met and reported monthly. Lead orientation and training for new Utilization Management staff related to managing role/workflow expectations. Perform case reviews of Utilization Management Coordinators evaluating policy/protocol adherence, interdisciplinary team collaboration, and utilization trends of engaged populations. Provide feedback related to productivity and caseload management opportunities. Adhering to company policies and procedures regarding confidentiality and privacy. Providing utilization management services and providing supervision and leadership. Responsible for directly managing the UM team or as defined by the UM Director. Manage each team member of the Utilization Management team through frequent communication, case reviews, performance evaluations, onsite assistance, and as a resource as needs arise. Responsible for promoting the ongoing development of all staff and maintaining a professional environment in which all staff can thrive and develop. Includes ongoing collaboration and communication with providers, clinical staff, case managers, and clients utilizing collaborative decision-making when appropriate. Be responsible for day-to-day interaction and quarterly JOM with client organizations to help run a high-quality UM operation. Regular and consistent attendance Other duties as assigned EDUCATION and/or EXPERIENCE : Registered Nurse with Active unrestricted US Registered Nurse license required Associates or Bachelors Degree required. 3 years direct, clinical nursing experience required. 2 years of Utilization Management or Case Management experience required. 2 year of supervisory, management or team lead experience required. Ability to demonstrate problem-solving, facilitation, and analytical skills. Microsoft Excel, PowerPoint, Outlook, Teams experience. Experience working both independently and, in a team-oriented, collaborative environment. BENEFITS: 401(k) Dental Insurance Health Insurance Life Insurance Vision Insurance Paid Time Off Free catered lunches Read Less
  • Contract Coordinator  

    - Alameda County
    SUMMARY: The Contract Coordinator is responsible for assisting the Con... Read More
    SUMMARY: The Contract Coordinator is responsible for assisting the Contracting and Legal Department for the coordination and review of all contracts. The Contract Coordinator is also responsible for implementing, organizing, and maintaining contract related documents. This is a collaborative role requiring critical thinking skills, independence, a strategic mindset, and attention to detail. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Manage and maintain Astiva’s contracts, including all day-to-day data entry, permissions/access and reporting, in an efficient, accurate and exceptionally organized manner. Review a wide range of commercial contracts and distill key pieces of data (e.g., expiration date and type, restrictive provisions, and assignability). Understand the contracting process, policies and procedures, requirements, fee schedule, including contracting support for ancillary services contracts, contract implementation and other duties as required. Manage reporting process for communicating and tracking contract expirations/renewals and additional reporting obligations to all areas of the business. Serve as liaison between the Contracting/Legal Department and other departments including, fielding and responding to various requests from the business and external parties. Manage electronic signature processes and contract workflows for the Contracting/Legal Department. Assist in developing the direct network of providers. Make recommendations to department leadership for improvement of any and all procedures and systems at Astiva Health. Other duties may be assigned. QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE : Bachelor’s degree from an accredited college or university with a focus on Business Administration, Healthcare Administration or Finance or equivalent combination of education and experience. Be able to work effectively with all levels of employees and management. Excellent written and verbal communication skills with experience presenting to various audiences. Have a practical, business-oriented approach to problem-solving and be able to effectively work with teams to meet business needs. Able to manage multiple priorities in a fast-paced environment. Preferred but not required Minimum of one (1) year of experience in Medical Group/IPA, Managed Care, and HMO. Minimum of one (1) year of experience in provider network development and/or provider network management capacity, account management, or provider relations experience in a managed care organization. In-depth knowledge of contracting, reimbursement, credentialing, and operations, and must be proficient with MS Office Suite and other database software. Knowledge of Medicare regulations, NCQA, HIPPA compliance BENEFITS: 401(k) Dental Insurance Health Insurance Life Insurance Vision Insurance Paid Time Off Catered lunches Read Less
  • Quality Improvement Coordinator  

    - San Diego County
    Job Title: Quality Improvement Coordinator Target Compensation Range:... Read More
    Job Title: Quality Improvement Coordinator Target Compensation Range: $23.00-$25.00/hour, depending on relevant qualifications and experience About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. Summary: The Quality Improvement Coordinator will be responsible for coordinating and implementing quality improvement initiatives related to HEDIS measures and risk adjustments/HCC. This individual will work with internal and external stakeholders to ensure compliance with HEDIS specifications, data collection, reporting, and improvement strategies. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned. Regular and consistent attendance. In office attendance is requested 5 days a week. Coordinate and partner with IPA/MSO delegates for HEDIS and risk adjustment data reporting Identify gaps and opportunities for improvement Collaborate with internal departments to review and implement projects and interventions to improve delivery of services and quality of care. Assist with audits and reviews to ensure data accuracy and validity Review and summarize collected data with trend analysis for additional provider educational opportunities. Attend health plan meetings as requested by department leadership. Stay updated on HEDIS and risk adjustment specifications, guidelines, and industry trends EDUATION and/or EXPERIENCE: 3+ years of quality improvement or healthcare related experience Familiarity of HEDIS measures, specifications, and reporting requirements Proficient in data analysis, Excel, and quality improvement methodologies Excellent communication, presentation, and interpersonal skills Ability to work independently and collaboratively in a fast-paced environment. Detail-orientated, organized, and problem-solving skills. Benefits: 401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Free lunches on site Read Less
  • Provider Support Coordinator  

    - Sacramento County
    Join Astiva Health – Where Compassion Meets Innovation At Astiva Healt... Read More
    Join Astiva Health – Where Compassion Meets Innovation At Astiva Health, we believe healthcare should be accessible, affordable, and deeply personal. Based in Orange, CA, we serve a diverse community through Medicare and HMO services designed to meet people where they are. We’re not just building networks, we’re building trust, equity, and better outcomes. If you’re ready to help reshape healthcare delivery with purpose and precision, we invite you to bring your talents to our team. What You’ll Do The Provider Support Coordinator (PSC) is entrusted with delivering exceptional service to Independent Practice Associations (IPAs), Medical Groups, Management Services Organizations (MSOs), providers, hospitals, and ancillary network providers. The PSC plays a vital role in the recommendation, development, and execution of Quality-of-Service strategies designed to enhance operational effectiveness and elevate provider satisfaction levels. Why Astiva? We’re more than a health plan—we’re a movement toward better care. At Astiva, you’ll find a culture of collaboration, innovation, and heart. We celebrate diversity, empower our teams, and invest in the communities we serve. Come build something meaningful with us. Your Impact and Core Responsibilities · Relationship Management: Foster strong, collaborative relationships with contracted Providers to ensure seamless communication and partnership. · Issue Resolution: Coordinate between Providers and internal teams to quickly resolve questions about eligibility, benefits, contracts, claims, and referrals via phone, voicemail, and email. · Data Accuracy: Conduct outreach to verify Provider information, ensuring the accuracy of the provider directory and compliance with regulatory requirements. · Portal Support Read Less
  • Quality Improvement Coordinator  

    - Los Angeles County
    Job Title: Quality Improvement Coordinator Target Compensation Range:... Read More
    Job Title: Quality Improvement Coordinator Target Compensation Range: $23.00-$25.00/hour, depending on relevant qualifications and experience About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. Summary: The Quality Improvement Coordinator will be responsible for coordinating and implementing quality improvement initiatives related to HEDIS measures and risk adjustments/HCC. This individual will work with internal and external stakeholders to ensure compliance with HEDIS specifications, data collection, reporting, and improvement strategies. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned. Regular and consistent attendance. In office attendance is requested 5 days a week. Coordinate and partner with IPA/MSO delegates for HEDIS and risk adjustment data reporting Identify gaps and opportunities for improvement Collaborate with internal departments to review and implement projects and interventions to improve delivery of services and quality of care. Assist with audits and reviews to ensure data accuracy and validity Review and summarize collected data with trend analysis for additional provider educational opportunities. Attend health plan meetings as requested by department leadership. Stay updated on HEDIS and risk adjustment specifications, guidelines, and industry trends EDUATION and/or EXPERIENCE: 3+ years of quality improvement or healthcare related experience Familiarity of HEDIS measures, specifications, and reporting requirements Proficient in data analysis, Excel, and quality improvement methodologies Excellent communication, presentation, and interpersonal skills Ability to work independently and collaboratively in a fast-paced environment. Detail-orientated, organized, and problem-solving skills. Benefits: 401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Free lunches on site Read Less

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