- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and… more
- LA Care Health Plan (Los Angeles, CA)
- Community Resource Center Specialist III Job Category: Customer Service Department: Community Resource Center-Westside Location: Los Angeles, CA, US, 90064 Position ... to achieve that purpose. Job Summary The Community Resource Center (CRC) Specialist III builds and maintains meaningful relationships with members of the community,… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- Bristol Myers Squibb (Sacramento, CA)
- …with patient interest at the core of decisions should apply. The NP PA Clinical Specialist will have no direct reports and report into the Regional NPPA CS Director. ... The Dermatology Clinical Specialist will have materials created to support them in...laws. + Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geography. + Immunology… more
- LA Care Health Plan (Los Angeles, CA)
- Care Management Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 12405 ... to achieve that purpose. Job Summary The Care Management Specialist II utilizes clinical skills and training to perform...caseload. Knowledge of community resources. Knowledge of Medi-Cal and Medicare regulations. Ability to work as a part of… more
- LA Care Health Plan (Los Angeles, CA)
- Enhanced Care Management Clinical Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... achieve that purpose. Job Summary The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and oversight activities associated… more
- Cognizant (Sacramento, CA)
- …improving everyday life. **Job Title: Sr QNXT and NetworX Product Specialist ** **Location:** **Remote** **Job ID: SO# 00065529751** **Role and Responsibilities:** . ... seek clarification when gaps are identified. . Interpret paper contracts for reimbursement . . Troubleshoot and remediate/workaround for claim pend issues. . QNXT… more
- Sharp HealthCare (San Diego, CA)
- …initiatives that support pharmaceutical contracting, procurement, distribution, utilization and reimbursement in the hospital and ambulatory care settings resulting ... **Preferred Qualifications** + 3 Years experience with managed care, PBM and/or Medicare Part D, Medicaid, Commercial Health Insurance. + Experience with Oncology… more
- Novo Nordisk (San Mateo, CA)
- …impact + Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... 401(k) savings plan; flexible spending accounts; employee assistance program; tuition reimbursement program; and voluntary benefits such as group legal, critical… more
- MetroLink (Los Angeles, CA)
- …network to perform your dental services. If you require treatment from a specialist , your contract dentist will handle the referral. Many services are covered at ... change dentists at any time, go to a dental specialist of your choice, receive dental care anywhere in...have the option of seeing out-of-network providers, but full reimbursement is not guaranteed. VSP has contracted with many… more