- Providence (CA)
- …organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance program, management of projects and continual ... assists the Claims leaders in managing a quality assurance program to ensure compliance with...Insurance terminology + Legal concepts + Liens + Electronic claims databases + Medical terminology **Skills required… more
- LA Care Health Plan (Los Angeles, CA)
- …Services/Population Health department. Advanced knowledge of and experience in health plan quality assurance (especially related to claims , health ... and analytical work related to the testing, validation, and quality assurance of business requirements for and...root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key… more
- Cognizant (Sacramento, CA)
- …coverage guidelines and regulations. * Experience in the analysis and processing of claims , utilization review/ quality assurance procedures. * Must be able ... - 4:30pm ET **Experience:** A minimum of 1 years claims processing is required. **Travel:** None required **About the...HCFA paper or EDI information. * Responsible for reviewing medical records when necessary to determine if service rendered… more
- Emanate Health (Covina, CA)
- …indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and ... company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and… more
- Envista Holdings Corporation (Pomona, CA)
- …The **Sr. Quality Engineer** plans and conducts activities concerned with the quality assurance of industrial processes, materials, and products. The Sr. ... working closely with cross-functional teams to develop, implement, and maintain quality assurance protocols that comply with regulatory requirements and… more
- Banner Health (CA)
- …documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. ... different focuses (Facility vs Profee)._ In this **Inpatient Facility-based HIMS Coding Quality Associate** position, you bring your **5 years of acute care… more
- Sharp HealthCare (San Diego, CA)
- …clinical ackground and skills. + Solid understanding of utilization management and quality assurance activities. + Excellent communication skills, both verbal ... + Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Quality Management) +… more
- Unilever (El Segundo, CA)
- …supply of Liquid IV for extraordinary hydration. **About the Role:** The Quality Assurance Compliance Manager is responsible for the development, implementation, ... and continuous improvement of our food safety and quality assurance programs throughout the supply chain...not limited to:** + Support compliance of certifications and claims including Non-GMO Project verified, Vegan, Gluten-Free, OSMO, NSF,… more
- Sharp HealthCare (San Diego, CA)
- …clinical background and skills. + Solid understanding of utilization management and quality assurance activities and concepts. + Excellent communication skills, ... direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan Chief Medical Officer. To ensure… more
- Subaru of America (Sacramento, CA)
- …staff. Works in partnership with Zone, District, and SOA personnel including Field Quality Assurance , Techline, and the Customer Advocacy Department (CAD). Must ... and delight our customers. SUMMARY Serves as Subaru of America's (SOA's) Service and Quality representative in the SOA Field. Travels to retailers on a regular basis… more