Current jobs related to Delegate Relations Representative - Rancho Cucamonga - Inland Empire Health Plan

  • Client Relations Representative II

    3 weeks ago

    Rancho Cucamonga, California, United States TRL Systems Full time

    Customer Care Representative IIAt TRL Systems, we have been dedicated to safeguarding individuals and their assets for over four decades. As a provider of integrated Fire Alarm, Nurse Call, and Security systems, our mission is to enhance safety and well-being, and your contribution is vital to this cause.What You Can Expect as Part of Our Team:Comprehensive...

  • Client Relations Specialist

    3 weeks ago

    Rancho Cucamonga, California, United States UCI Full time

    At UCI, we are dedicated to transforming client inquiries into valuable business relationships. Our consultative method has significantly enhanced our clients' brand visibility and opened new avenues for growth within our organization. Our entry-level Customer Service and Sales Representatives serve as the primary contact for our customer accounts,...

  • Client Relations Specialist

    3 weeks ago

    Rancho Cucamonga, California, United States UCI Full time

    At UCI, we are dedicated to transforming our clients' product inquiries into successful partnerships. Our consultative methodology has significantly enhanced our clients' brand visibility and opened new avenues for growth within our organization. Our entry-level Customer Service and Sales Representatives serve as the primary liaison for our customer...

  • Marketing/Community Relations Liaison

    4 months ago

    Rancho Cucamonga, United States Bright Haven Hospice Care Corp Full time

    Job DescriptionJob DescriptionJOB DESCRIPTION SUMMARYAre you a Marketing/Community Relations Liaison with Hospice experience or are willing to discover the arena of hospice care? Are you looking for immediate employment as a Marketing/Community Relations Liaison?We’re looking for Marketing/Community Relations Liaison who are responsible for managing...

  • Marketing/Community Relations Liaison

    4 months ago

    Rancho Cucamonga, United States Bright Haven Hospice Care Corp Full time

    Job DescriptionJob DescriptionJOB DESCRIPTION SUMMARYAre you a Marketing/Community Relations Liaison with Hospice experience or are willing to discover the arena of hospice care? Are you looking for immediate employment as a Marketing/Community Relations Liaison?We’re looking for Marketing/Community Relations Liaison who are responsible for managing...

  • Customer Relations Outfitter

    4 months ago

    Rancho Cucamonga, United States Bass Pro Shops Full time

    Pay Range: $17.00 - $22.50POSITION SUMMARY:The Customer Relations Associate performs various Customer Service activities, to include greeting and acknowledging all customers in a prompt and friendly manner, handling merchandise with care, providing information and direction to customers.ESSENTIAL FUNCTIONS:Secures all firearms brought into the store with...

  • Marketing and Sales Representative

    1 month ago

    Rancho Cucamonga, United States Viper Marketing Full time $43,000 - $56,000

    Job DescriptionJob DescriptionViper Marketing is a business consulting firm looking to hire a talented individual to take our company to new heights. Our mission is to continue facilitating the growth of our partners through innovative marketing campaigns and intangible brand strategies with consumers that diverge us from competitors. As a Marketing and...

  • Front Desk Representative

    3 months ago

    Rancho Cucamonga, United States Arrowhead Orthopaedics Full time

    Job Type Full-time Description Patient Services Representative (Front Desk) It is our goal to provide the finest Orthopaedic care possible. This philosophy requires that all office staff and providers be sensitive and responsive to patients' needs and preferences. To ensure that we hire and retain the quality of staff needed for implementing our philosophy...

  • Customer Service Representative

    7 days ago

    Rancho Cucamonga, California, United States Quantilus Full time

    {"title": "Customer Service Representative", "description": "Job SummaryWe are seeking a highly skilled Customer Service Representative to join our team at Quantilus. As a key member of our customer support team, you will be responsible for providing exceptional service to our clients, resolving complex technical issues, and collaborating with our...

  • Customer Service Representative

    4 days ago

    Rancho Cucamonga, United States LHH Full time

    Bilingual Customer Service RepresentativeHybrid role: Rancho Cucamonga, CAWe are seeking a dedicated and patient Customer Service Representative with excellent communication skills and a strong ability to handle customer inquiries and complaints. The ideal candidate will have experience in a healthcare or managed care setting and possess strong technical...

  • Customer Service Representative

    1 day ago

    Rancho Cucamonga, United States LHH Full time

    Bilingual Customer Service Representative Hybrid role: Rancho Cucamonga, CA We are seeking a dedicated and patient Customer Service Representative with excellent communication skills and a strong ability to handle customer inquiries and complaints. The ideal candidate will have experience in a healthcare or managed care setting and possess strong technical...

  • Customer Service Representative

    4 days ago

    Rancho Cucamonga, United States LHH Full time

    Bilingual Customer Service RepresentativeHybrid role: Rancho Cucamonga, CAWe are seeking a dedicated and patient Customer Service Representative with excellent communication skills and a strong ability to handle customer inquiries and complaints. The ideal candidate will have experience in a healthcare or managed care setting and possess strong technical...

  • Retail Sales Representative

    3 weeks ago

    Rancho Cucamonga, California, United States AMEZIEL INC Full time

    Become a Part of Ameziel Inc.Are you enthusiastic about the home furnishings sector and eager to advance your career? Ameziel Inc., the North American division of Ziel Technologies, a renowned leader in ready-to-assemble furniture, is on the lookout for a committed Retail Sales Representative to join our growing B2B sales team.Position Overview:We are in...

  • BDC Representative

    4 months ago

    Rancho Cucamonga, United States The Matian Firm, APC Full time

    Job DescriptionJob DescriptionThe Matian Firm is looking for a BDC Representative for Legal Sales. In this role one is responsible for handling inbound clientele service requests, such as appointment setting, case vetting, and general questions. The BDC Representative for Legal Sales is also responsible for screening potential client calls in order to...

  • B2B Sales Representative

    3 weeks ago

    Rancho Cucamonga, California, United States AMEZIEL INC Full time

    Job OverviewBenefits:401(k)Dental insuranceHealth insuranceVision insuranceAmeziel Inc., a prominent entity in the KD furniture sector, is the North American division of Ziel Technologies, a global leader with a billion-dollar presence. We operate across various categories, including indoor and outdoor furniture, home organization solutions, and pet...

  • Customer Service Representative

    2 weeks ago

    Rancho Cucamonga, California, United States TRL Systems Full time

    About the RoleWe are seeking a highly motivated and customer-focused individual to join our team as a Customer Care Representative. As a key member of our sales team, you will play a critical role in developing and maintaining customer relationships, driving sales growth, and enhancing the overall customer experience.Key ResponsibilitiesDevelop and maintain...

  • Customer Service Representative

    1 week ago

    Rancho Cucamonga, California, United States Taymax Group Full time

    Job SummaryWe are seeking a highly motivated and customer-focused individual to join our team as a Member Services Representative. As a key member of our team, you will be responsible for providing exceptional customer service to our members, prospective members, and guests.Key ResponsibilitiesCustomer ServiceProvide a superior level of customer service to...

  • Provider Call Center Representative

    4 days ago

    Rancho Cucamonga, United States Alura Workforce Solutions Full time

    Title Provider Call Center Representative Position Type: Hybrid Mon./Fri. remote and Tues./ Wed./ Thurs. onsite Schedule: M-F, 8:00 am - 5:00 pm DESCRIPTION Join our dynamic team as a Bilingual Provider Call Center Representative! Under the guidance of the Provider Call Center Supervisor, you'll be the Provider Advocate, responding to calls with a friendly...

  • Call Center Representative

    3 days ago

    Rancho Cucamonga, United States AppleOne Full time

    Job DescriptionJob DescriptionAre you a customer service professional fluent in both English and Spanish? Join a dynamic team as a Provider Call Center Representative! This hybrid position offers the perfect balance of remote flexibility and in-office collaboration, ideal for someone who enjoys helping others and thrives in a fast-paced environment. ...

  • Compliance Auditor III

    2 months ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Compliance Auditor III is responsible to lead and conduct key activities of the IEHP Compliance Audit Program. The Compliance Audit III will oversee...

Delegate Relations Representative

4 months ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

**What you can expect**

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience**

The Delegate Relations Representative (DRR) is responsible for developing and maintaining strong and consistent relationships with IEHP delegated entities. The DRR serves as the liaison for delegated entities and their network on contracted providers related to provider network access, network adequacy, provider quality performance, provider regulatory compliance, member experience, and ensure alignment with IEHP Mission, Vision, Values, and strategic goals. The DRR is responsible for the interpretation of all provider and quality related IEHP policies, procedures, and processes. The DRR is integral in the implementation and maintenance of network and quality performance improvements with IEHP delegated entities to continually improve quality metrics, member quality of care and compliance standards.

**Key Responsibilities**:
1. Conduct IPA/MSO orientations, continuous training, and education to Providers Services staff. Maintain accurate and timely log of IPA visits in compliance with NCQA standards, and DHCS and CMS regulatory
requirements and plan requirements.
2. Act as an IPA Advocate and liaison between Providers, IPAs, MSOs and IEHP departments in resolving Member, Provider, and IPA issues and concerns.
3. As assigned, visit all Delegates on a periodic basis, focusing visits, strategically under the direction of the Director of Delegation Oversight and Relations, in alignment with IEHP’s quality initiatives and strategic priorities.
4. Monitor and support IPA and delegate contracted Providers through utilization reports, Provider Report Cards, quality performance data, and cases presented through the Customer Relationship Management (CRM) tool to provide training to improve Provider performance, close care gaps, and improve access to care.
5. Lead investigation and resolution with IPA counterparts for Provider grievances to ensure response and timeliness rates meet IEHP and regulatory requirements.
6. Promote electronic submission capabilities including the timely and complete submission of encounter data, claims and utilization data related to IEHP’s quality metrics, namely HEDIS.
7. Communicate with IPA staff regarding Provider issues, quality initiatives, and Provider changes, and to resolve Member and Provider cases.
8. Attend internal meetings with Quality and Delegation Oversight and participate in external Provider meetings and focus groups.
9. Assist with training and in servicing of IPAs and their Providers with interpreting IEHP reports, including eligibility, capitation, claims, and quality reports.
10. Communicate changes regarding Provider Directory to ensure timely update of systems and directories.
11. Work with IPAs to prepare timely coverage plans for the compliant transfer of Member PCP assignments.
12. Coordinate with Contracts Department and IPAs to address Provider inquiries concerning rate/service changes and claims disputes.
13. Partner in the regular review and development of the Provider Policy and Procedure Manual for Provider Relations related activity.
15. Assist in monitoring and oversight of the IPA Provider Network Support Bonus program through data report tracking, analysis against predefined performance criteria.
16. Assist in coordinating, scheduling, and preparation of materials for IEHP trainings / in-services for IPAs, with emphasis on Provider Relations, Network Management, and Quality P4P Program support.
17. Present Provider Network Update and other reports at IEHP/IPA Joint Operations Meetings.
18. As applicable, review and verify compliance of the Specialists Network, identifying gaps and requesting IPA response and submission of Specialist credentialing to close network gaps.
19. Review and verify Provider Directory information and lead investigation and resolution of reported Provider Directory inaccuracies.
20. Any other duties as required ensuring Health Plan operations are successful.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

**Perks**

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
- CalPERS retirement
- 457(b) option with a contribution match
- Generous paid time off
- vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account - Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional development
- Compet