DEPARTMENT
OBJECTIVE:
The mission of the California Department of Managed Health Care (DMHC) is to protect consumers health care rights and ensure a stable health care delivery system. The DMHC accomplishes
its
mission
by
ensuring
the
health
care
system
works
for
consumers.
The
DMHC protects the health care rights of more than 29.8 million Californians by regulating health care service
plans, assisting
consumers
through
a
consumer Help
Center, educating
consumers
on their rights and responsibilities, and preserving the financial stability of the managed health care system.
PROGRAM
OBJECTIVE:
The
Help
Center
assists
consumers
with
health
care
issues
and
through
its
regulatory
authority ensures that managed health care consumers receive the medical care and services to which they are entitled.
GENERAL
DESCRIPTION:
Under the direction of the Assistant Chief Counsel, Help Center - Legal Affairs Branch (LAB), the incumbent performs sensitive and less complex legal work for the Department of Managed Health
Cares
Help
Center
related
to
the
regulation
of
health
care
service
plans
pursuant
to
the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act, Health and Safety Code section 1340, et seq.)
and other work as required. Duties include evaluating and resolving less complex consumer complaints, making investigative inquiries, performing legal research, providing legal advice and counsel, determining health plan compliance with the Knox-Keene Act, and performing other special projects as required.
TYPICAL
DUTIES:
Employee
must
be
able
to
perform
the
following
duties
with
or
without
reasonable
accommodation.
PERCENTAGE
JOB
DESCRIPTION
Essential
(E)/Marginal
(M)
40% (E)
Investigate, evaluate, and resolve both expedited and non-expedited consumer
complaints
filed
with
the
Departments
Help
Center
against
health plans through the research, interpretation, and application of state and federal laws, regulations, court decisions, and other legal authorities and
departmental
policies;
respond
to
legal
correspondence
received
from counsel acting on behalf of consumers, health plans, government agencies, providers, and advocates; conduct negotiations with both in- house and outside counsel for health plans; and prepare correspondence to consumers, health plans, and advocates on the resolution of their complaints containing detailed legal analysis and an explanation of legal findings made during the course of the Help Centers investigation.
30% (E) Perform a wide variety of legal research, including reviewing and interpreting legal precedents and principles contained within federal and state health care statutes, regulations, cases, policies, and contracts for the purpose of providing legal advice and counsel to the fol
D
DEPARTMENT OF MANAGED HEALTH CARE