- CenterWell (Sacramento, CA)
- …Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing ... as medical, dental and vision benefits, 401k with company matching, tuition reimbursement , 3 weeks paid vacation time, paid holidays, work-life balance, growth, a… more
- Centene Corporation (Sacramento, CA)
- …Remote position. Must work PST. California resident strongly preferred **Prior Medicare STAR ratings, HEDIS, and Quality Improvement experience needed.** **Valid ... service or quality improvement Complex project management experience **Experience with Medicare and/or NCQA preferred:** Pay Range: $68,700.00 - $123,700.00 per year… more
- Stanford Health Care (Palo Alto, CA)
- …with federal and state laws pertaining to the revenue capture and reimbursement . + Directs and coordinates communication with Technology and Digital Solutions to ... MediCal/Medicaid APG Grouper, HCPCS and CPT-4 coding schemas. + Knowledge of Medicare , Medicaid and other third-party billing coverage and compliance issues. +… more
- LA Care Health Plan (Los Angeles, CA)
- …Care Services (DHCS), Department of Public Social Services (DPSS), Centers for Medicare and Medicaid Services(CMS), LACC - CalHers, and National Committee for ... in a healthcare environment required. Previous experience with Medi-Cal and Medicare in a managed care environment. Preferred: Tableau experience. Skills Required:… more
- LA Care Health Plan (Los Angeles, CA)
- …Tracks and trends daily error reports, analyze results from Call Center, MRP, Medicare , MRU, Outbound and Outreach, and LA Care Covered scorecards and recommend ... or Quality Assurance. Knowledge of and experience of Medi-Cal, Medicare , and Covered California. Skills Required: Good oral and...benefits including + Paid Time Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision… more
- LA Care Health Plan (Los Angeles, CA)
- …position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services ... 5 years of experience in Managed Care working with Medicare , Medi-Cal and other State Sponsored programs. Knowledge of...benefits including + Paid Time Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision… more
- LA Care Health Plan (Los Angeles, CA)
- …of member appeals and grievances for all product lines (Medi-Cal, Medi-Cal Direct, Medicare , PASC-SEIU and LA Care Covered) in a manner consistent with regulatory ... Health Care, Department of Health Care Services, Centers for Medicare & Medicaid Services, as well as requirements from...benefits including + Paid Time Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision… more
- Option Care Health (Hayward, CA)
- …is maintained by providing direct patient care 20-40% of the time. In a Medicare Certified Home Health agency, this position may also serve as the alternate ... + Acts as Administrator and/or Director of Nursing of the Home Health Agency for Medicare certified home health agencies in the absence of a director or Manager of… more
- UCLA Health (Los Angeles, CA)
- …all this and more at UCLA Health. As a key member of our Medicare Advantage Operations team, you will develop detailed requirements specifications to meet our ... Five or more years of experience managing enrollment, claims, or encounters in a Medicare or managed care environment required + Five or more years of experience… more
- Option Care Health (Sacramento, CA)
- …expert in health care compliance including, but not limited to FWA, Medicare & Medicaid billing requirements, and interactions with healthcare professionals. Lead or ... such as the Anti-Kickback Statute, Stark Law, HIPAA and Medicare /Medicaid requirements. **Basic** **Qualifications** Knowledge of and experience with laws,… more