Employment

 

It is the policy of Physicians Medical Group (PMG) to recruit, hire and promote on the basis of merit, qualifications, and competence.  This applies to all categories of employment such as managerial, professional, technical, or any other staff.  No aspect of employment shall be influenced by race, color, national origin, religion, sex, sexual orientation, age, or a physical or mental disability.  All employment decisions will be made solely upon the individual's qualifications as related to the requirements of the position being filled.

Please be advised that all employment at PMG is employment-at-will. This employment (if offered) may be terminated at the will of either PMG or yourself, with or without cause, at any time, with or without notice.

PMG of Santa Cruz offers competitive salaries, a comprehensive benefit package and a 401 (k)-retirement plan.  For immediate consideration, please e-mail your cover letter and resume to resume@pmgscc.com or mail/fax to:

 

Physicians Medical Group of Santa Cruz

Human Resources Dept.

5200 Soquel Drive, Suite 203

Santa Cruz, CA.  95062

FAX: (831) 464-7044

Job Openings

Currently Physicians Medical Group of Santa Cruz is recruiting for the following position:
 

Case Manager
 
The Case Manager works closely with the Nurse Case Managers, Medical Director and patient’s physicians to ensure that health care services are delivered in a timely and cost effective manner.
 
A bachelor's degree in social work, psychology, nursing or related degree required, plus three years previous experience in a managed care environment (Medical Group, Healthplan, or Acute Care Hospital).
 
This full-time position is eligible for benefit package and requires working knowledge of MS Office / Windows applications, excellent oral and written skills.
 

Nurse Case Manager
 
There is an immediate opening for CA licensed RN with two years previous experience including authorization review and case management in a managed care environment.
 
Nurse Case Managers work closely with the Medical Director to evaluate, monitor and assure the appropriateness, benefits/coverage and medical necessity of care delivered to our members.

This full-time position is eligible for benefit package and requires working knowledge of MS Office / Windows applications, excellent oral and written skills.
 

Health Plan Coordinator

Physicians Medical Group is looking for a Health Plan Coordinator. This individual will be responsible for customer service, issues resolution and providing general information to patients, physicians and medical staff, health plans, employers and other providers. Performs electronic data input.

Principal Responsibilities
Answer incoming telephone calls and questions from prospective members, members, providers and healthplans regarding eligibility, authorizations, reimbursement and claims inquiries. Assist new members with selection of Primary Care Physician (PCP), or those that wish to change PCP.

Resolve issues for the provider network related to authorizations, claims and eligibility via electronic communication. Respond to all issues within two business days.

Perform claim review; determine payment responsibility per DFR grid.

Enter and edit authorization data into EZCAP based on urgency. Review and approve authorizations based on auto approval criteria.

Use the ADS as appropriate for authorization processing.

Research eligibility and benefits as needed related to authorization or claims issues.

Process daily, weekly and monthly reports as assigned.
Adhere to PMG standards, policies and procedures, attend general staff meetings and department meetings as required..

Knowledge, Skills and Abilities Required

Must be a high school graduate or equivalent

Must possess a minimum of one (1) year’s previous experience in an HMO environment.

General understanding and knowledge of healthcare, medical terminology, health insurance claims, CPT coding and ICD-9 coding.

Must demonstrate ability to operate computer systems, including Microsoft Office, copier, fax and telephone equipment.

Ability to take direction and work independently.

Must demonstrate excellent interpersonal skills necessary to communicate effectively with a variety of individuals while conducting oneself in a courteous and professional manner in person, by telephone and e-mail communications.

Must demonstrate the ability to read, write and communicate fluently in English.

Physical Demands and Work Environment
Physical demands: While performing the duties of the job, the employee is required to walk; sit; use hands and fingers to operate job related equipment; occasionally reach with hands and arms; occasionally climb stairs; talk and hear. The employee must occasionally lift and/or move up to 15 pounds. Vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment: While performing the duties of this job, the employee is exposed to an indoor building climate. The noise level in the work environment is usually minimal.

Reporting Relationship

Reports to Operations Supervisor
  

Mission Statement

 

Our mission is to develop and manage joint hospital and physician medical delivery systems to better meet the health needs of the community though the provision of high-quality, efficient medical care.

 

Purpose

 

PMG provides administrative and managerial services to member physicians, hospitals and organized physician groups within Santa Cruz County.  It provides an organizational environment in which physicians of high quality, while remaining independent, can continue to serve the community.  Through a variety of health care vehicles it helps align the financial incentives of physicians and hospitals in efficient delivery systems.

 

Equal Opportunity / ADA Statement

 

PMG is an Equal Opportunity Employer and makes employment decisions on the basis of merit.  Company policy prohibits unlawful discrimination based on race, color, creed, gender, religion, marital status, age, national origin, physical disability (including HIV and AIDS), mental disability, medical condition, sexual orientation, or any other consideration made unlawful by federal, state, or local laws.  PMG will make reasonable accommodations in order to comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability unless undue hardship would result.