- Sharp HealthCare (San Diego, CA)
- …experience in claims, utilization review, appeals or member services in a managed care environment **Preferred Qualifications** + Bachelor's Degree Business ... and follow-up. **Knowledge, Skills, and Abilities** + Thorough understanding of managed care principles and models. + Thorough understanding of health services… more
- HealthTrust Workforce Solutions (Campbell, CA)
- …measures are taken to correct unsatisfactory results. 14. Ensures compliance of managed care operations with all laws, regulations, rulings, ordinances and ... of ten years of progressively responsible executive management experience in a Managed Care environment with at least five years in a significant general… more
- Cedars-Sinai (Los Angeles, CA)
- …accounts to ensure payment and resolution. + Monitors, evaluates, and reviews Cedars-Sinai Managed Care contracts and reconcile to payments received. + Ensures ... with Supervisor and EIS to open tickets to load, fix and test managed care contracts. + Performs payer discrepancies analysis and prepare documentation for payer… more
- Robert Half Accountemps (Van Nuys, CA)
- …setting. The Hospital Patient Account Rep will also be responsible for managing Medicare managed care , commercial, PPO/HMO and Medical managed care . ... hospital billing and collection processes with accuracy and efficiency * Handle Medicare managed care , commercial, PPO/HMO, and Medical managed care *… more
- Dignity Health (Rancho Cordova, CA)
- …the Pharmacy Services for Dignity Health Medical Foundation. Reporting to the Director of Managed Care , this individual serves as the leader for operations of ... and Price Clinic.The Manager will work closely with the Director of Managed Care on Dignity Health Medical Foundation initiatives related to pharmacy services.… more
- Sharp HealthCare (San Diego, CA)
- …clinical practice of medicine. + Previous experience as a physician executive in a managed care environment, preferably as an HMO Medical Director. + California ... a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks. + Assists… more
- Humana (Sacramento, CA)
- …services such as inpatient rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed ... The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments… more
- Molina Healthcare (Long Beach, CA)
- …* 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare ... discuss and resolve issues related to utilization management, pharmacy, quality of care , and correct coding. * Independently delivers training and presentations to… more
- Dignity Health (Oxnard, CA)
- …more years of account management experience working with a medical group or IPA in a managed care environment. + 5 or more years' experience working in a similar ... authorization, claims administration and provider network administration. Familiarity with managed care and self-insurance products and benefits. **Preferred… more
- Scripps Health (San Diego, CA)
- …fee-for-service, partial risk, and full global risk HMO, PPO, and Ancillary services managed care agreements with health plans on behalf of Scripps Health's ... actively engage in the analysis, management, accounting, and budgeting of all managed care agreements. Establish effective lines of communication between Payer… more