- BrightSpring Health Services (Union City, CA)
- … solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled ... individual to join our team. PharMerica is a non-retail pharmacy that focuses on providing exceptional customer service and...Identifies and resolves issues of denials or follow-up of claims , by maintaining current knowledge of Medicaid claim… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp Health ... of our members related to their medical, behavioral health and pharmacy needs. This position also provides the physician cohesive collaboration necessary… more
- CVS Health (Sacramento, CA)
- …Trifacta, Linux OS, GCP/ AWS/ Azure. + Experience working with medical and/or pharmacy claims data. + Experience in healthcare industry, including health ... to join our PBM Customer Reporting group as a Senior Reporting Analyst within our Compliance Pharmacy ...You will work with a collaborative, close-knit team on pharmacy and member specific claims data including,… more
- Elevance Health (Los Angeles, CA)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Royal Electric (Pleasanton, CA)
- …documentation including but not limited to submittals, RFI's, delay notices, potential claims , and extended overheads. + Maximize cash flow by balancing project cost ... Dependent care (Daycare children & elderly - work related), & Transit + Pharmacy discounts + Kisx Card (Surgery & Imaging Program) + Opportunity for tuition… more
- Kyndryl (Sacramento, CA)
- …Healthcare IT Applications - Systems Engineer (EPIC) - (10) is a senior -level, client-facing role dedicated to driving the adoption, integration, and optimization of ... expertise in leading healthcare payer and provider application platforms (eg, Pharmacy , Lab, Electronic Medical Record, Imaging, Medical Device Integrations, Contact… more
- WTW (San Francisco, CA)
- …specialty consulting services including clinical/health management program design, pharmacy solutions, disability/absence management strategies and claims ... all try to have some fun! + Exposure to Senior leadership and thought leaders across the firm At...etc. + Gain specialized knowledge in areas such as pharmacy , life and disability insurance, health equity and wellbeing,… more
- Sharp HealthCare (San Diego, CA)
- …SHP and its Chief Medical Officer. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality ... with medical management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan Chief Medical Officer)… more
- Humana (Sacramento, CA)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, ... or data requires an in-depth evaluation of variable factors. As the Senior Clinical Compliance Professional , you will develop and/or evaluate compliance… more
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