- Prime Healthcare (Ontario, CA)
- …team! Responsibilities This position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for ... across all aspects of the Employee Health Plans. The VP of Health Plan Operations and Claims will provide strategic leadership and development of the… more
- Highmark Health (Sacramento, CA)
- …and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations . **ESSENTIAL RESPONSIBILITIES** + Perform management ... business. This will require aligning new models to the health plan 's strategic objectives based on a...Plan , organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and… more
- Elevance Health (Walnut Creek, CA)
- …overturn primary decision. + Works with various departments including Provider Solutions and Health Plan Operations leadership when necessary, to determine ... root cause and appropriate resolution. + Must work with Claims Operations to remediate impacted claims. **Minimum Requirements:** + Requires a HS diploma or GED and… more
- Dignity Health (Bakersfield, CA)
- …**Qualifications** **Minimum Qualifications:** - Minimum five (5) years of experience in the health plan and/or healthcare operations industry with extensive ... of the organization including but not limited to analysis of population health metrics, network clinical, financial, utilization, and patient satisfaction in support… more
- Evolent (Sacramento, CA)
- …transformative growth opportunities at customer accounts + Strong knowledge of health plan operations , care/utilization management, claims processing, ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health … more
- Prime Healthcare (Ontario, CA)
- …and state financial reporting regulations. + Collaborate with cross-functional teams including Health Plan Operations , Patient Access, Marketing, IT, and ... Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare...implement, and manage the Revenue Integrity & CDM Compliance Plan . + Ensure compliance with CMS Price Transparency Rule… more
- Centene Corporation (Sacramento, CA)
- …as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations . Completes retrospective claims audits on a ... and abuse. + Serve as a Claims regulatory resource related to the health plan operations and compliance audits. + Maintain quality and productivity standards… more
- WelbeHealth (Elk Grove, CA)
- …five (5) years of progressive experience in provider relations, network management, or health plan operations /account management in a complex healthcare ... Senior Manager, Provider Partnership is accountable for overseeing daily operations while mentoring and coaching a team, fostering their...where every person feels uniquely cared for. + BENEFITS: Health Coverage on Day 1, Paid Parental Leave, 401K… more
- Prime Healthcare (Ontario, CA)
- …Corporate Finance, including hospital Controllers and CFOs, Legal, Managed Care, and Health Plan Operations . Qualifications EDUCATION, EXPERIENCE, TRAINING ... Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare...not limited to, paid time off, a 401K retirement plan , medical, dental, and vision coverage, tuition reimbursement, and… more
- LA Care Health Plan (Los Angeles, CA)
- …$105,267.00 (Min.) - $139,478.00 (Mid.) - $173,689.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by the state of ... Information Technology Development Operations Engineer II Job Category: Information Technology Department:...County residents. We are the nation's largest publicly operated health plan . Serving more than 2 million… more