- Humana (Sacramento, CA)
- …community and help us put health first** The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation ... of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to… more
- Providence (CA)
- …provide training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services ( CMS ) Medicare Secondary Payer ... more years of experience reporting third party liability settlements to Centers for Medicare and Medicaid Services ( CMS ), and federal and state licensing and/or… more
- Ensono (Los Angeles, CA)
- …Interchange (EFI), Next Generation Desktop (NGD), Electronic File Interchange (EFI), and the CMS Identity Management System (IDM). **Why Ensono?** Ensono is ... and FIPS 140-2, as applicable. + Maintain and renew certifications required for system access and management , ensuring continued compliance and eligibility. +… more
- LA Care Health Plan (Los Angeles, CA)
- …lead generation activities and overall lead book of business oversight. For the Medicare and Commercial lines of business, territory management /outreach and lead ... Management Ensures the integrity of data. Effectively utilizes the Customer Relationship Management (CRM) system to manage the sales referral pipeline and… more
- CVS Health (Sacramento, CA)
- …(if applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… more
- CenterWell (Sacramento, CA)
- …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- Sutter Health (Emeryville, CA)
- … management , and quality improvement. + Proven history in population health management , risk adjustment, and quality measurement (HEDIS, CMS Stars). + ... provider networks, and health plan leadership. **Knowledge:** + In-depth understanding of CMS Stars, HEDIS, and regulatory requirements for Medicare Advantage… more
- Ventura County (Ventura, CA)
- …The Joint Commission (TJC), California Department of Health Services (DHCS), Centers for Medicare & Medicaid Services ( CMS ), and Department of Managed Health ... Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem… more
- LA Care Health Plan (Los Angeles, CA)
- …or CM. Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services( CMS ) requirements for health plan compliance with UM ... Utilization Management Admissions Liaison RN II Job Category: Clinical...Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type:… more
- Sutter Health (Sacramento, CA)
- …(HMO), Preferred Provider Organization (PPO), Patient Processing Service (PPS),Centers for Medicare and Medicaid Services (GR) Grouper ( CMS ) preferred. + ... you are interested in joining Sutter Health! **Organization:** SHSO-Sutter Health System Office-Valley **Position Overview:** The Physician Advisor (PA) is a key… more