- Dignity Health (Bakersfield, CA)
- …care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, ... will lead the development and execution of Medicaid value-based care strategy and foster strategic relationships with key external stakeholders, including… more
- CVS Health (CA)
- …open to qualified candidates within the United States. **Required Qualifications** 10+ years of Managed Care experience in health plan and/or PBM roles 10+ years ... CMS audit experience HPMS experience **Preferred Qualifications** 15+ years of Managed Care experience in health plan and/or PBM roles 15+ years Medicare… more
- Humana (Sacramento, CA)
- …policy administration or related field;work experience may meet this need + 5 + years managed care experience + 5 + years in Medicaid program implementation or ... and clinical operations; Medicaid preferred + Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to… more
- Abbott (Alameda, CA)
- …**What You'll Do** + Lead the negotiation of complex contract terms for Managed Care / Market Access contracts across large PBM/GPO relationships. + Employ a ... lead healthier, happier lives. As a global leader in diabetes care , Abbott is constantly...contract development and negotiation for the Market Access / Managed Care Channel. The position will work… more
- Molina Healthcare (Los Angeles, CA)
- …* At least 5 years health care experience, and at least 2 years of managed care experienced utilization management. * Ability to manage conflict and lead ... or management certification. Prior experience with InterQual, MCG guidelines, PEGA and managed care UM processes. * Medicaid/Medicare population experience. *… more
- Valor Health (Gardena, CA)
- …VA and works with these patients utilizing rules set forth by the VA for co- managed care . + Conducts individual, group, and family and marriage counseling and/or ... for them with respect and through methods that lead to superior clinical outcomes. Valor is different because...the time of each patient visit. + Assists in co- managed care collaboration with non-VA providers, and… 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 ... Additional Responsibilities + Collaborates with the CEO, CFO, CIPO and COO on managed care strategy, risk-based initiatives, and budget alignment with clinical… 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 ... care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical...plans to address issues and improve plan and network managed care performance. + Collaborates with Chief… more
- Children's Hospital Los Angeles (Glendale, CA)
- …the billing and follow-up related to HMO's, PPO's, Medi-Cal, CCS, GHPP, PCCM's Managed Care and outside organizations. Responds to inquiries and resolves ... for inpatient and or outpatient billing for commercial and managed care payers. Familiarity with medical billing...healthier futures. Children's Hospital Los Angeles (CHLA) is a leader in pediatric and adolescent health both here and… more
- Evolent (Sacramento, CA)
- …and proficiency + Personally initiate and foster executive level relationships at managed care organizations or health systems and large provider groups ... **:** The **VP,** **Growth** **-** **Pay** **e** **r** will lead strategic partnerships with health plans. + Develop and...cycles requiring diverse stakeholder management + Knowledge of the managed care and provider markets (both payers… more