- Humana (Sacramento, CA)
- …by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases)… more
- UCLA Health (Los Angeles, CA)
- …Health ICM Coordinator plays a key role in supporting our Utilization Management team to ensure safe, high-quality, and cost-effective care for patients enrolled ... in UCLA Medicare Advantage and Intensive Case Management programs. Under the supervision of the RN Assistant Director, you will coordinate referrals, authorizations,… more
- UCLA Health (Los Angeles, CA)
- …reporting. The Administrative Assistant also monitors incoming faxes, prepares documentation for CMS and Health Plan audits, and provides general clerical support to ... Monitor fax queues and identify document types for appropriate routing. + Support CMS and Health Plan audits by retrieving and compiling relevant documentation. +… more
- Carrington (Anaheim, CA)
- …financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered. + Moderate ability to conduct quality assurance reviews. ... MS Word, Excel. + Strong attention to details and excellent time management and organizational skills. + Comprehensive writing skills, including proper punctuation… more
- Sutter Health (San Francisco, CA)
- …and professional standards affecting case management practice in an integrated delivery system : including but not limited to: CMS , Title 22, CHA Consent ... of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through… more
- Cardinal Health (Sacramento, CA)
- …audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories as well as ... and recommendations; presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. +… more
- Dignity Health (Los Angeles, CA)
- …the new Grand Tower. You will leverage your expertise in data management , analysis, and reporting to identify insights, support quality initiatives, and contribute ... OPPE, FPPE). + Participates in an integral role to ensure compliance with CMS HIQRP/HOQRP, TJC, Leapfrog, etc., data collection and reporting of process and outcome… more
- LA Care Health Plan (Los Angeles, CA)
- …simple appeals while adhering to Center for Medicare and Medicaid Services ( CMS ), California Department of Health Care Services (DHCS), Department of Managed Health ... Medical terminology. Preferred: In depth knowledge of DHCS, NCQA, CMS , DMHC regulartories and guidelines. Licenses/Certifications Required Licenses/Certifications Preferred… more
- LA Care Health Plan (Los Angeles, CA)
- …program, ensuring compliance with Centers for Medicare and Medicaid Services ( CMS ), Department of Health Care Services (DHCS), and state/federal requirements. Ensure ... and enforcement actions involving SIU and FWA matters. Duties Continued Risk Management and Oversight Conducts strategic planning to use resources to meet current… more
- LA Care Health Plan (Los Angeles, CA)
- …of complaints in compliance with Centers for Medicare and Medicaid Services ( CMS ), California Department of Health Care Services (DHCS), Department of Managed Health ... complaints, complex provider appeals and State Fair Hearing adhering to CMS , DHCS, DMHC, MRMIB and NCQA standards and regulations. Intakes, acknowledges,… more