Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Reach Out has been serving the Inland Region of Southern California for 52 years, underpinning a deep well of experience in community cohesiveness and organizing, and empowering communities to make transformational change on social justice issues. When needed, our aim is to be an effective, positive disruptor of the status quo. Our core work of strengthening communities takes many forms, from direct services to youth and families, to deep root cause work in building the health and quality of life of our region.
We are seeking an Outreach Specialist who will be responsible for developing networks among individuals, groups, organizations, and agencies through policy community-based approaches. This position is required to provide on-site services and/or outreach interventions in diverse, lower socioeconomic areas at various times of the day and evening.
Essential Functions
· Community outreach, conduct presentations, community involvement and participation on key committees, organizations, collaboratives in the Inland Empire.
· Establish partnerships with local agencies and neighboring cities, communities, businesses and agencies.
· Work within contract/funding source guidelines/requirements.
· Partner with program staff/volunteers and interns as needed.
· Collect data and enter outreach outcome statistics.
· Cross-department collaboration, training and support.
· Create and maintain a creative, positive, sustainable, and supportive work environment.
· Ensures the adequacy of information delivered to the community and the provision of high quality, culturally sensitive referrals.
· Displays sensitivity to the service populations cultural and socioeconomics characteristics.
· Performs work in a safe manner at all times and abide by safety practices.
· Performs other duties as assigned.
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments.
Experience
· A minimum of five years of community engagement experience.
Licenses and Certifications
· Valid California Driver’s License is required.
· Must maintain insurance on vehicle.
Additional Qualifications
To perform this job successfully, an individual should have the following general knowledge
· Experience conducting outreach to culturally diverse communities.
· Experience in work within substance use prevention, nutrition, community safety, etc.
· Ability to work a flexible schedule including some evenings, if needed.
· Sound organizational and time management skills to manage high and varied activity level.
· Ability to be an excellent representative of the agency to the community.
· Excellent written and verbal communication skills.
· Excellent organizational skills and an ability to manage and prioritize duties are necessary to be successful in this position.
· Ability to effectively and successfully interact with individuals from diverse socio-economic/ethnic groups.
· Proactive, flexible, creative, and enthusiastic attitude.
· Ability to make sound judgments and follow and give complex directions.
· Ability to work with diverse groups of stakeholders, including parents, children, and community officials.
· Fluent English/Spanish preferred.
Physical and Mental Demands:
· Able to work in a high paced high demand environment
· Able to travel to and attend meetings throughout the counties in the Inland Empire
· Annually attend out of State or County conferences per contract requirements
· Able to work flexible hours including evenings and weekends
· Able to publicly speak, give presentations, facilitate workshops, etc.
· Able to work with diverse populations
Reach Out is an Equal Opportunity / Affirmative Action Employer committed to providing equal employment opportunities to all qualified applicants without regard to race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability or handicap, pregnancy, gender identity and/or expression, sexual orientation, military or veteran status, or any other characteristic protected under applicable federal, state or local law.
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