- Evolent (Sacramento, CA)
- …opportunity sizing. **Healthcare Industry Experience:** Familiarity with clinical workflows, payer operations, or healthcare AI applications is preferred. **Why Join ... Us?** Opportunity to drive impactful AI initiatives in a rapidly evolving industry. Collaborative environment with cross-functional teams, including data science, engineering, and operations. Competitive compensation, benefits, and opportunities for… more
- Elevance Health (Walnut Creek, CA)
- …of 5 years' experience in a behavioral health setting, either provider or payer ; or any combination of education and experience, which would provide an equivalent ... background. + Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable by state laws) is required. **Preferred Skills, Capabilities, and Experiences:** + Candidates who reside… more
- Highmark Health (Sacramento, CA)
- …control frameworks, and assessment methodologies, particularly as applied to healthcare ( payer and provider) business processes. + Knowledge of relevant regulatory ... guidelines, vendor management, sourcing and procurement, and completing assessments of vendors + Excellent resource and project planning capabilities, decision making skills, history of results-oriented delivery, and effective team building across a… more
- Otsuka America Pharmaceutical Inc. (San Francisco, CA)
- …compliantly to competitive threats and opportunities + Educates office staff on payer guidelines and reimbursement procedures to increase pull through + Effectively ... utilizes promotional materials + **Selling Skills, Engagement & Account Pull Through** + Maintains ongoing awareness of internal support team resources available throughout the ecosystem and utilizes appropriately + Applies market and industry knowledge to… more
- Cognizant (San Francisco, CA)
- …House:** TriZetto offers product solutions to the healthcare industry from streamlining payer processes to automating insurance operations. The practice has its own ... ecosystem of businesses including positions in marketing, project management, and technical roles - such as developers and analysts. **Products include:** + Clinical CareAdvance and CareAdvance Provider + EngageMember + EngageProvider + Facets + NetWorX… more
- Evolent (Sacramento, CA)
- …years of professional experience in claims-based healthcare analytics with a payer , provider, clinical vendor, managed care, or related healthcare consulting entity ... + Ability to communicate clearly with diverse stakeholders to solve problems; ability to translate between business needs and analytical needs + Exceptionally strong analytical abilities, with track record of identifying and communicating insights from… more
- HCA Healthcare (Riverside, CA)
- …and consultant to hospital case managers and hospital staff in the reduction of payer denials and in the denial and appeals process, as requested by the Case ... Management Department and Patient Accounting Services + You will attend corporate, group, division, and national meetings sponsored by HCA corporate to train and support quality improvement, risk management, patient safety, case management, medical staff… more
- Conduent (Los Angeles, CA)
- …Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide ... variety of pharmacy records against our client's pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be required to represent our clients and conduct "on-site" pharmacy audits. **Responsibilities** +… more
- UCLA Health (Los Angeles, CA)
- …experience with Medi-Cal, Medicare, HMO, and PPO insurances + Experience using online payer sites with the ability to check claim status, denials, and eligibility + ... Knowledge of MS Word and MS Excel software + Knowledge of CPT, ICD-10, and HCPC codes + Must be an effective multi-tasker in order to meet daily production and quality standards UCLA Health is a world-renowned health system with four award-winning hospitals… more
- Evolent (Sacramento, CA)
- …product marketing and related sales operations functions, preferably in healthcare payer /provider services companies . Proven track record of accomplishment on ... development and execution of marketing strategies . Excellent communication and interpersonal skills, adept at navigating senior-level stakeholder discussions . Experience building and developing team members . Knowledge of the managed care and oncology market… more