- LA Care Health Plan (Los Angeles, CA)
- …Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM. Licenses/Certifications ... (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of California to… more
- Centene Corporation (Sacramento, CA)
- …PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective ... and abuse. + Serve as a Claims regulatory resource related to the health plan operations and compliance audits. + Maintain quality and productivity standards… more
- Actalent (Sacramento, CA)
- …interdisciplinary team meetings and represent the UM department effectively. + Maintain IPA, Health Plan compliance standards. + Enforces Company policies ... necessity + Collaborate with hospital teams, providers, IPA case managers, and health plan representatives + Conduct in-person hospital rounds 2-3 days per week,… more
- UCLA Health (Los Angeles, CA)
- …medical appropriateness by using established clinical protocols and health plan resource tools + Assess compliance with healthcare regulations, accreditation ... responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and regulations. This role involves evaluation… more
- Dignity Health (Bakersfield, CA)
- …Develop agenda and presentation for Contacting Meetings. - Collaborates with Provider Relations, Compliance , and Health Plan Strategy to ensure aligned ... managing performance, and fostering collaborative partnerships with providers and health plan stakeholders. This includes capitation, fee-for-service, and… more
- LA Care Health Plan (Los Angeles, CA)
- …financial solvency compliance with regulatory and contractual requirements for plan partners, PPGs, capitated hospitals, specialty health plans, and vendors. ... (Mid.) - $188,015.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency...and implementation of reports and tools for corrective action plan issuance and non- compliance notifications. Manages the… more
- LA Care Health Plan (Los Angeles, CA)
- Health Plan Territory Representative II Job Category: Sales & Marketing Department: Product Sales Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... (Mid.) - $82,867.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency...all lines of business. Duties Continued Product Sales Regulatory Compliance : Adheres to compliance of Centers for… more
- Cardinal Health (Sacramento, CA)
- …audit and monitoring plan . The Manager has supervisory responsibility for all Compliance Audit staff. **_What is expected of you and others at this level_** + ... **_What Ethics & Compliance contributes to Cardinal Health_** Ethics & ...Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) +… more
- Cardinal Health (Sacramento, CA)
- …KRIs as well as reporting processes to provide ongoing updates to leadership on health of the IT compliance program effectiveness, risk exposure, and ... well as completes risk assessments. The IT Governance and Compliance function within the organization develops, enhances, and maintains...Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) +… more
- Highmark Health (Sacramento, CA)
- …incumbent is responsible for the collaborative and iterative development of the risk and compliance plan for these entities across all areas in the enterprise ... This job is responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within… more
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