- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning,… more
- Sharp HealthCare (San Diego, CA)
- …practices. **What You Will Do** Under the direction of the Manager of EDI Management , the Systems Analyst-EDI Mgmt will use technical and analytic skills to complete ... Plan operational data sets including, but not limited to, eligibility, claims , provider, billing, capitation, financial and structural. The Systems Analyst-EDI Mgmt… more
- UCLA Health (Los Angeles, CA)
- …all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM coordinators and ... + Concurrent Review + Continuity of Care + Retro Claims + Retrospective Review + Referral Automation Business Rules/Configuration...degree required + Five or more years of utilization management required + Four or more years of managerial… more
- Cardinal Health (Sacramento, CA)
- …systems. This role reports to the VP of the Revenue Cycle Management team. **Responsibilities** + Lead end-to-end revenue cycle operations for radiation oncology ... charge capture, coding, billing, and collections + Ensure all oncology-related claims are submitted accurately and within payer timelines to prevent denials… more
- CVS Health (Sacramento, CA)
- …with heart, each and every day. **Position Summary** The Senior Analyst, Account Management will serve as a fully dedicated advocate to senior employees and their ... Liaising with healthcare providers. + Submitting and tracking out-of-network claims . + Managing administrative processes such as pre-authorizations and… more
- Cedars-Sinai (Los Angeles, CA)
- …Financial Services, performing duties which may include reviewing and resubmitting claims to third party payors, performing account follow-up activities, updating ... duties include: + Participates in department meetings and provides feedback to management on how to improve department processes. Adheres to instructions, verbal and… more
- Elevance Health (Los Angeles, CA)
- …Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case ... and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all...Validates accuracy and quality standards as set by audit management for the auditing concept, valid claim identification, and… more
- Marriott (Los Angeles, CA)
- …**Schedule** Full Time **Located Remotely?** N **Position Type** Management **Pay Range:** $73,000-$97,000 annually **Bonus Eligible:** Y **JOB ... * High school diploma or GED; 3 years experience in the human resources, management operations, or related professional area. OR * 2-year degree from an accredited… more
- Marriott (Chula Vista, CA)
- …**Schedule** Full Time **Located Remotely?** N **Position Type** Management **Pay Range:** $73,000 - $97,000 annually **Bonus Eligible:** ... * High school diploma or GED; 3 years experience in the human resources, management operations, or related professional area. OR * 2-year degree from an accredited… more
- CVS Health (Sacramento, CA)
- …to litigated claims . + Strong attention to detail and project management skills. + Experience overseeing and answering written discovery. + Ability to work ... **Position Summary** As a Product Liability Litigation Adjuster, Risk Management , you will be responsible for managing lawsuits and...activities. + Utilizing legal skills to oversee and manage claims against CVS from the initiation of suit through… more