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

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

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

the

regulation

health

care

service

plans

pursuant

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

able

perform

the

following

duties

with

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

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

DEPARTMENT OF MANAGED HEALTH CARE

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