- Evolent (Sacramento, CA)
- …license required per business needs . Active Board Certification in Adult Medical Oncology . Strong clinical, management , communication, and organizational ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Sutter Health (Santa Rosa, CA)
- … medical terminology, pathologies, disease states, and related information for a medical management plan. + Knowledge of acute and chronic disease and ... medical terminology, pathologies, disease states, and related information for a medical management plan. + Carry out calculations and execute basic math… more
- Dignity Health (Rancho Cordova, CA)
- …Supervisor of Utilization Management is responsible and accountable for coordination of services for Mercy Medical Group and Woodland Clinic Medical ... criteria sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management … more
- Lompoc Valley Medical Center (Lompoc, CA)
- …assess, and monitor risks that may impact the organization's operations, projects, and services . * Develop and implement risk management strategies and action ... * Skill in establishing and maintaining effective working relationships with co-workers, management , patients, medical staff, and the public. * Skill in… more
- Prime Healthcare (Anaheim, CA)
- …hospital dedicated to providing the community with high-quality, compassionate healthcare. Key services include general medical and surgical inpatient care and ... treatment, emergency services , surgical services , behavioral health, comprehensive heart center, and diagnostic imaging.... Technician is responsible for the assessment and basic management of medical , trauma and environmental emergencies… more
- Prime Healthcare (Anaheim, CA)
- …hospital dedicated to providing the community with high-quality, compassionate healthcare. Key services include general medical and surgical inpatient care and ... treatment, emergency services , surgical services , behavioral health, comprehensive heart center, and diagnostic imaging.... Technician is responsible for the assessment and basic management of medical , trauma and environmental emergencies… more
- Robert Half Accountemps (Los Angeles, CA)
- …Proficient in handling UB-04 forms and hospital billing processes. * Strong knowledge of medical appeals and denial management . * Familiarity with HMO and PPO ... Description A Hospital is looking for an experienced Medical Collections Specialist to join its Medical...process UB-04 claims for both inpatient and outpatient hospital services . * Investigate and resolve unpaid claims by following… more
- Elevance Health (Los Angeles, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or call ... initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. + Notifies ordering… more
- Sedgwick (Sacramento, CA)
- …via phone or writing. + Provides clear follow-up recommendations for ongoing medical management of claims, ensuring appropriate recommendations are made. + ... scores. + Acts as a clinical resource to claims examiners, offering guidance on medical management of claims, including comprehension of medical terminology… more
- CVS Health (Sacramento, CA)
- …**Required Skills** + Strong understanding of the healthcare industry, including medical management , claims processing, and provider networks. + Extensive ... **This role is responsible for ensuring the accuracy and compliance of medical claims, which involves applying various editing rules and guidelines to ensure… more