- 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
- 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
- Humana (Sacramento, CA)
- … health condition management, health outcomes, patient experience, and plan operations . **Location:** remote of hybrid if close to Louisville Reporting ... part of our caring community and help us put health first** Health Quality and Stars (HQS)...committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare… 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
- Robert Half Technology (Martinez, CA)
- …Bachelor's degree with 4+ years of experience in quality measurement, process improvement, or health plan operations OR Master's degree with 2+ years of ... execution support for strategic initiatives that strengthen compliance, streamline operations , and enhance member and provider experiences. Unlike traditional… 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
- TEKsystems (Los Angeles, CA)
- …auditors and cross-functional staff. Preferred Qualifications + Experience with Medicare guidelines and health plan operations . + Experience in claims system ... to change and may be subject to specific elections, plan , or program terms. If eligible, the benefits available...employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee… 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