- Wider Circle (Los Angeles, CA)
- …Scope of Appointment, the presentation of the product, sales conversion and relationship management of a Medicare beneficiary * Daily tasks include completing a ... a fast-growing boutique insurance agency focused on helping people understand their Medicare Benefits. We work with underserved populations to help them navigate … more
- Humana (Sacramento, CA)
- …radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
- Humana (Sacramento, CA)
- …team to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the ... key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with...or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of… more
- CVS Health (Sacramento, CA)
- …+ Ensuring that the relevant information is captured in Customer Relationship Management system (CRM) + Other duties as assigned. **Accountabilities** : ... an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part...and standards with a robust knowledge with respect to CMS and states regulations. + Ability to multitask, and… more
- Humana (Sacramento, CA)
- …practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials,… more
- UCLA Health (Los Angeles, CA)
- …or 5+ years of experience with residency, required + At least 3 years of Medicare Experience, including CMS compliance, required + Minimum 3 years of experience ... Description As our Medicare Advantage Staff Pharmacist, supporting the pharmacy department...groups, required + In-depth knowledge of pharmacy supply chain management , including pharmacy networks and specialty pharmacy, required +… more
- UCLA Health (Los Angeles, CA)
- …Extensive understanding of healthcare industry standards, workflows, policies, procedures, and system environments. + Strong metadata management skills with the ... Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be...technical specifications for healthcare measures from organizations such as CMS , DHCS, NCQA, and others. + Serve as a… more
- UCLA Health (Los Angeles, CA)
- …into a vital role at New Century Health Plan and coordinate the care for our Medicare Advantage members. As a Care Management Nurse, you will focus on improving ... care gaps for members enrolled in the Complex Care Management program. + Support members in participating in the...care coordination, or a related field + Experience with Medicare Advantage plans and knowledge of CMS … more
- Humana (Sacramento, CA)
- … management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve… more
- LA Care Health Plan (Los Angeles, CA)
- …Russian, Tagalog, Vietnamese. Knowledge of translation industry trends and technologies (workflow/ content management system , translation memory, machine/AI ... Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services ( CMS )) related to translations/alternative formats for… more