- Stanford Health Care (Palo Alto, CA)
- …ASA + Knowledge of medical management statistics relating to UM/CM and prior authorization process management. + Extensive knowledge of risk stratification ... methods and complex case management criteria. + Working knowledge of regulatory entities and regulations (CMS, DMHC, NCQA, etc.) + Working knowledge of care management systems. + Time Management: the ability to organize and manage multiple priorities +… more
- Dignity Health (Oxnard, CA)
- …+ Familiarity with third party administrator operations such as eligibility, prior authorization , claims administration and provider network administration. ... Familiarity with managed care and self-insurance products and benefits. **Preferred Qualifications:** + Experience working as an account manager in a direct to employer health plan preferred. This is a work from home postion. Candidate will be required to… more
- Centene Corporation (Sacramento, CA)
- …management and healthcare providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically ... appropriate determinations + Collects, documents, and maintains all member's clinical information in health management systems to ensure compliance with regulatory guidelines + Assists with providing education to providers on utilization processes to promote… more
- Elevance Health (Rancho Cordova, CA)
- …and/or experience preferred. + Formulary, clinical rules, pharmacy claims analysis, and/or prior authorization experience for a pharmacy benefit manager or ... health plan strongly preferred. + Proficiency with Microsoft Office products, most notably expertise in Excel for reporting, Word, PowerPoint, Teams, and Outlook strongly preferred. + One year or more Excel experience working with large data files and other… more
- Cardinal Health (Fresno, CA)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections._ The Lead - ... Pre-submission Billing Team is responsible for overseeing the daily operations of the billing team focused on pre-submission activities. This role ensures accurate and timely charge capture, supports denial prevention strategies, and drives performance through… more
- Sumitomo Pharma (Sacramento, CA)
- …services for SMPA's product portfolio, including hub services (benefits investigation, prior authorization , and appeals support), field reimbursement managers, ... Patient Assistance Program (PAP) and copay assistance programs + Drive **data-driven decision-making** , leveraging patient insights and real-world evidence to refine program effectiveness, + **Vendor Oversight** + Oversee **third-party service providers** ,… more
- Actalent (Sacramento, CA)
- …patients. Essential Skills + Proficient in healthcare practices. + Experience with prior authorization processes. + Expertise in case management. + Knowledge ... of Skilled Nursing Facilities (SNF). Additional Skills & Qualifications + Possession of a valid CA LVN License. Work Environment This position offers a remote work arrangement with a Monday-Friday day shift. The office setting at the corporate location is… more
- Cardinal Health (Sacramento, CA)
- …care and timely access to necessary services + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes + Help patients ... understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance +… more
- Cardinal Health (Fresno, CA)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections._ The Revenue Cycle ... Supervisor is responsible for generating revenue by monitoring and pursuing payment for all unpaid and delinquent denied claims. They also act as a liaison between the provider, payors, and patients for charge submission and maintain daily and monthly… more
- UCLA Health (Los Angeles, CA)
- …specialty pharmacy, required + Proven background in pharmacy clinical operations, including prior authorization , appeals, grievances + Experience with EPIC EHR ... functionality + Proficient in Microsoft Word and Excel + Strong commitment to patient confidentiality and thorough knowledge of HIPAA requirements, required UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity,… more
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