- Humana (Sacramento, CA)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an… more
- J&J Family of Companies (Fresno, CA)
- …to address critical access and affordability issues for patients. + Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). + Execute business in accordance with the highest ethical,… more
- J&J Family of Companies (San Jose, CA)
- …to address critical access and affordability issues for patients. . Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). . Execute business in accordance with the highest ethical,… more
- Sharp HealthCare (San Diego, CA)
- …experience in claims, utilization review, appeals or member services in a managed care environment. **Preferred Qualifications** + Bachelor's degree in business ... and follow-up. **Knowledge, Skills, and Abilities** + Thorough understanding of managed care principles and models. + Thorough understanding of health services… more
- CenterWell (Sacramento, CA)
- …The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care , PBM, market and regulatory insights to develop, and/or ... the Medicaid lines of business. + Utilizes broad understanding of pharmacy, managed care , PBM, market and regulatory insights to support the development of… more
- UCLA Health (Los Angeles, CA)
- …related field required + Minimum of five years' experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required + Minimum ... of five years' experience with CMS processes in a Medicare or Managed Care environment required + Experience with CMS processes is a plus + Knowledge of SQL… more
- UCLA Health (Los Angeles, CA)
- …field required + Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required + Minimum of ... five (5) years' experience with CMS processes in a Medicare or Managed Care environment required + Experience with CMS processes is a plus + Knowledge of SQL… more
- Molina Healthcare (San Francisco, CA)
- …in the health care field including, but not limited to, provider's office, managed care organization, or other health care environment. * 3+ years ... language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region. * Advises Network Provider Contract… more
- Humana (Sacramento, CA)
- …first** The Formulary Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care , PBM, market and regulatory insights to develop, and/or ... Humana's Medicare line of business. + Utilizes broad understanding of pharmacy, managed care , PBM, market and regulatory insights to support the development of… more
- Molina Healthcare (Riverside, CA)
- …SKILLS & ABILITIES** : * 5-7 years experience in Healthcare Administration, Managed Care , Provider Contracting and/or Provider Services, including 2+ years ... of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members, in addition to identifying VBP… more