- Sharp HealthCare (San Diego, CA)
- …in Healthcare Management, Business, or other degree acceptable with combination of education and managed care experience. + 3 Years experience in a managed ... apply knowledge as part of day-to-day job responsibilities. + Knowledge of managed care principles, reimbursement methodologies, and healthcare delivery systems.… more
- Prime Healthcare (Lynwood, CA)
- …Account Resolution is the lead responsible for the timely follow-up of Managed Care /Commercial accounts. Communicates clearly and efficiently by phone with ... and reports. Responsible to obtain State collection guidelines if applicable. Reviews managed care contracts. Qualifications + Minimum of four years hospital… more
- Molina Healthcare (San Diego, CA)
- …integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, or equivalent combination of relevant… more
- Highmark Health (Sacramento, CA)
- …federal and state rules as well as a solid working knowledge of managed care operations, compliance program structures, information security and audit ... in leading interdepartmental and cross-functional strategy development. + Experience with managed care , Medicare and federal and/or state regulations, quality… more
- Dignity Health (Santa Cruz, CA)
- …management experience + Previous management experience in a union environment + Prior managed care or integrated delivery systems experience + Master's degree in ... will help our patients receive the highest standard of care , improve patient experiences and ensure the team delivers...full spectrum of medical and surgical specialties with each managed as discreet departments and integrated as part a… more
- Elevance Health (Costa Mesa, CA)
- …acute care setting. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. + Managed Care experience. For candidates ... be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within the scope of licensure for members with complex and… more
- Dignity Health (Bakersfield, CA)
- …build strong relationships with providers and hospital leadership preferred. - Prior managed care or integrated delivery systems experience preferred - Master's ... will help our patients receive the highest standard of care , improve patient experiences and ensure the team delivers...full spectrum of medical and surgical specialties with each managed as discreet departments and integrated as part a… 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 ... Responsibilities + Collaborates with the CEO, CFO, CIPO and COO on managed care strategy, risk-based initiatives, and budget alignment with clinical goals. +… more
- Sharp HealthCare (San Diego, CA)
- …a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks. + Assists ... corrective action plans to address issues and improve plan and network managed care performance. + Collaborates with Chief Medical Officer in creating and… 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
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