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 nearly 200 primary care pediatricians and 240 pediatric sub-specialists. 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, almost 72,000 children are enrolled in CPMG through eight managed care Health Plan contracts and two Medi-Cal contracts. 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.

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

RN Case Manager
Full Time

CPMG has an exciting opportunity for a dedicated and caring professional to join our team as a RN Case Manager. This team member will work with all members of the health care team to coordinate the delivery of care through assessment, planning, facilitation, and patient advocacy to ensure cost-effective quality outcomes of care. Additionally, this position will collaborate with all members of the health care team to ensure optimal outcomes are reached while appropriate utilization occurs.

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

  • Registered Nurse with current unrestricted California License.
  • Minimum of three years clinical experience, with pediatric background preferred.
  • At least two years managed care experience with case management.
  • Good computer skills with knowledge of Excel, Word, PowerPoint, Outlook, and Access
  • Excellent verbal and written communication skills
  • Strong analytical and problem solving skills.

For consideration please email resume and cover letter including salary requirements. Children’s Physician Medical Group offers the full scope of benefits, a great compensation package and opportunities for professional growth. EOE. For more information please visit our website at https://cpmgsandiego.com

 

Customer Service Representative
Full Time

The Customer Service Representative promotes favorable relationships with members, providers, and health plans through the prompt, accurate and courteous resolution of issues; receives and respond to customer inquiries (telephone, written and electronic) that may pertain to all phases of CPMG operations including authorizations, claims inquiries and provider network access; documents all customer contacts, including resolution or action taken to refer question to proper entity; assists and educates member families with navigation of HMO processes. The position will also include: Data entry/processing of authorization requests, including verification of benefits, research of authorization history, provider notes, use of correct CPT/ICD9 codes; providing referrals within CPMG network; working collaboratively with all professional entities relating to CPMG business; and assisting colleagues as necessary on special projects with time critical deadlines.

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

  • High school degree or equivalent education with computer keyboarding skills.
  • Three (3) years experience working with Health Plans/Health Care.
  • Excellent verbal and written language skills to answer customer concerns in simple, understandable language.
  • Previous customer service experience in a physician office, hospital, or other healthcare setting.
  • The ability to work both independently and as part of a team, maintain confidentiality and exhibit a professional demeanor.

Knowledge of health plan benefits, claims, ICD-9/CPT coding.

For consideration please email resume and cover letter including salary requirements. Children’s Physician Medical Group offers the full scope of benefits, a great compensation package and opportunities for professional growth. EOE. For more information please visit our website at https://cpmgsandiego.com

 

Provider Relations Representative
Full Time

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):

  • Bachelor’s degree highly desirable/ minimum high school degree or equivalent education
  • 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.

For consideration please email resume and cover letter including salary requirements. Children’s Physician Medical Group offers the full scope of benefits, a great compensation package and opportunities for professional growth. EOE. For more information please visit our website at https://cpmgsandiego.com

“Dr. Barbadillo was my doctor when I was a baby and now that I have a baby she is her doctor. I love her clinic, it’s always neat and clean. Just wanted to say thank you!”

– Anonymous