- UCLA Health (Los Angeles, CA)
- …hospital charges are processed promptly, accurately, and in compliance with Centers of Medicare & Medicaid Services ( CMS ), Medi-Cal, and other policies. You'll ... + Manages and conducts special project reviews. + Maintain compliance with CMS , Medi-Cal, and health plan billing regulations. + Analyze complex billing/financial… more
- NTT DATA North America (Merced, CA)
- … administrators. **Required Qualifications:** + 5+ years pf proven experience with Medicare claims, including a deep understanding of CMS requirements and ... a detail-oriented and experienced DSNP Business Analyst with specialized knowledge in Medicare and D-SNP claims processing. The ideal candidate will bring a strong… more
- Providence (Fortuna, CA)
- …committed to delivering top-notch healthcare, earning a 5-star rating from the Center for Medicare and Medicaid Services ( CMS ) as well as a Top Performing ... **Description** Care Manager RN - Case Management at Providence Redwood Memorial Hospital in Fortuna, CA. This position is Full-Time and will work 8-hour Day shifts.… more
- Cedars-Sinai (Marina Del Rey, CA)
- …The role encompasses the meticulous oversight and continuous evaluation of Centers for Medicare & Medicaid Services ( CMS ) metrics, including but not limited to ... rigorous compliance and performance with both internal and external standards (eg, CMS , The Joint Commission, and Title 22 etc.) Through their expertise, they… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Services As Needed / Per ... + Req #:42003-31126 + FTE:0.01 + Posted:Yesterday **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN is responsible… more
- Molina Healthcare (San Diego, CA)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Humana (Sacramento, CA)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Sunnyside Nursing and Post-Acute Care (Torrance, CA)
- …+ REPORTING REQUIREMENTS: Timely submits required data to the Center for Medicare and Medicaid Services ( CMS ). + CHART AUDITS/COMPLIANCE: Coordinates monthly ... + The Health Information Manager (HIM) is responsible for the overall management of the Medical Records Department, including the development and implementation of… more
- Amazon (San Francisco, CA)
- …Monitor and ensure adherence to patient safety regulations, including OSHA, CDC, CMS , and Medicare guidelines. - Cross-Functional Collaboration: Work with senior ... and Effects Analysis - Strong knowledge of OSHA, CDC, CMS , and Medicare regulatory requirements. - Experience...strongly preferred. - BSN or MSN License - Program management experience - Hands on experience with PI tools… more
- Molina Healthcare (Riverside, CA)
- …values. Utilize a combination of recruitment, mentoring, education, and channel management techniques to ensure brokers meet assigned objectives and enrollment ... Molina's enrollment, profitability, and retention goals. Additionally, ensure brokers follow CMS and State Guidelines, along with basic ethical sales practices and… more