- Cedars-Sinai (Los Angeles, CA)
- **Job Description** Job Summary The Director of Managed Care develops and implements managed care and payer relations strategies including contract ... industry groups (eg, CHA, HASC, APG) to shape and align Cedars-Sinai's managed care strategy. **Qualifications** Education: + **Bachelor's Degree Required** -… more
- Cedars-Sinai (Beverly Hills, CA)
- …implementation financial initiatives; assisting in the interpretation of policies/procedures/practices. Managed Care Reporting: + Prepare reports and ... metrics, identifying trends, variances, and areas for improvement. + Analyze managed care contracts for compliance and financial performance, identifying… more
- Prime Healthcare (Lynwood, CA)
- …seeking new members to join our corporate team! Responsibilities The Senior Managed Care Biller/Collector is responsible for both billing and collections, ... with the specific payer guidelines, policies, procedures, and compliance regulations for managed care . This includes maintaining the deficiency lists used to… more
- Dignity Health (Bakersfield, CA)
- …loading benefit information. Responsibilities may include: - Develop all hierarchy levels in managed care platform for customer setups and configuration - Review ... adhere to all Policies and Procedures for the benefit workflow within the managed care platform - Support quality reviews and testing of all benefit setup prior… more
- Sutter Health (Goleta, CA)
- …knowledge base of health care delivery and case management within a managed care environment. + Comprehensive knowledge of Utilization Review, levels of ... for Medicare and Medicaid Services (GR) Grouper (CMS), Department of Managed Health Care , National Committee for Quality Assurance (NCQA). + A broad knowledge… more
- Cardinal Health (Sacramento, CA)
- …in defining, developing, and executing go-to-market strategies that drive engagement with Managed Care Organizations (MCOs), health plans, and payor networks. ... and lifecycle marketing. The ideal candidate brings expertise in the managed care landscape-paired with the ability to translate data and insights into… more
- Molina Healthcare (Long Beach, CA)
- …Must have intermediate level MS Excel experience, + Familiarity with Enrollment and Managed Healthcare experience is required. + Must be able to research and analyze ... data using SQL is required. + Experience with QNXT is preferred. + Medicare/ medicaid membership exp required Required soft skill include but are not limited to : + Excellent communication + Possess a team player attitude + Ability to work in a diverse… more
- Molina Healthcare (Long Beach, CA)
- …Must have intermediate level MS Excel experience, + Familiarity with Enrollment and Managed Healthcare experience is required. + Must be able to research and analyze ... data using SQL is required. + Experience with QNXT is preferred. + Medicare/ medicaid membership exp required Required soft skill include but are not limited to : + Excellent communication + Possess a team player attitude + Ability to work in a diverse… more
- LA Care Health Plan (Los Angeles, CA)
- …and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience ... with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed ...as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services,… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred Bachelor's Degree Experience Required: At least 2 years of experience in Managed Care with specific experience in resolving member and provider ... interpret and apply regulations. At least 5 years of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs. Knowledge of… more