- Rady Children's Hospital San Diego (San Diego, CA)
- …as an independent, the Compliance Specialist's primary function is to ensure the Managed Care business unit is meeting compliance with rules, policies, and ... JOB SUMMARY: Reporting to the Director of Claims and Systems Administration and functioning...changes, legislative efforts, and /or industry trends specific to Managed Care operations and keeps Management Team… more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …Oversees internal clinical audits and external reporting to HRSA, UDS, HEDIS, and managed care plans. + Oversee the Credentialing and Privileging department and ... Additional Responsibilities + Collaborates with the CEO, CFO, CIPO and COO on managed care strategy, risk-based initiatives, and budget alignment with clinical… more
- A Bright Future, Inc. (Pleasant Hill, CA)
- …of the entire staff assigned to work at specific homes, coordinating personal care , training, and support to meet the goals and objectives of the individuals ... vendor's established policies, under the general supervision of the director . TITLE: Community Support Facilitator STATUS: Full-Time, Regular CLASSIFICATION:… more
- Sharp HealthCare (San Diego, CA)
- …of care for SRS Members. Ensure timely and appropriate processing of managed care referrals to meet specific healthcare criteria in a cost-effective manner ... + 2 Years utilization/Case Management experience, preferably in a Managed Care setting. + Experience as a...necessity are issued under the direction of the Medical Director or designee. + Data and documentation collectionGather relevant,… more
- CenterWell (San Diego, CA)
- …put health first** The Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel. + Develops, plans, implements, ... analyzes, and organizes clinical operations for a specific location managed . + Conducts/delegates the assessment and reassessment of patients, including updating of … more
- Sharp HealthCare (San Diego, CA)
- …and productivity of a work unit or units and for maintaining the quality of care within that work unit and or programs. Assists the VP/CNO/ Director with ... and provides daily work direction to achieve unit level of care and organizational objectives. Contributes to budget development and maintains responsibility… more
- HCA Healthcare (Riverside, CA)
- …+ You will provide medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, ... regarding delegated utilization management and disease management operations under managed care contracts. You will meet all regulatory/contractual/accreditation… more
- Sharp HealthCare (San Diego, CA)
- … Committee. **Knowledge, Skills, and Abilities** + Demonstrated working knowledge of managed care , capitation, provider payment mechanisms and member benefits. + ... Will Do** Under the direction of the Sharp Community Medical Group (SCMG) Director for Health Service and in collaboration with the Health Services leadership team,… more
- The County of Los Angeles (Los Angeles, CA)
- …species, and suspected water contamination, to correct deficiencies at all lake facilities managed by the department. Assists the Assistant Director , Parks and ... Join us and discover a rich selection of health care options, robust retirement plans and the flexibility to...+ No 07 What is largest budget have you managed that included salaries? + None + $1 to… more
- Providence (Anaheim, CA)
- …for additional information. + 1 year of experience working with physicians in a managed care /IPA, Medical group, health plan or MSO environment with Provider ... **Description** Under the supervision of the Director , the Provider Relations Representative functions as a...Bachelor's Degree in Healthcare Management. + 2 years of Managed care Provider Relations experience. **Why Join… more