- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Elevance Health (Cerritos, CA)
- … medical policy and Medicare Coverage Determinations. The **Associate Medical Director , Clinical Operations** is responsible for supporting the medical ... Benefits Management Medical Necessity Guidelines, client-specific health plan medical policy, state mandates/policies and Medicare determinations + Conduct… more
- Bayer (Irvine, CA)
- …minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - Southern California** **Associate Director ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Prime Healthcare (Ontario, CA)
- …seeking new members to join our corporate team! Responsibilities The Corporate Director Government Reimbursement and Reporting will serve as a lead in understanding ... oversight. Specifically, has experience overseeing Interns & Residents program reimbursement, Medicare bad debts, S-10 Charity, and Total Hospital bad debt logs,… more
- AccentCare, Inc. (Corona, CA)
- Overview Find Your Passion and Purpose as a Territory Operations Director - Home Health RN Registered Nurse Reimagine Your Career in Corporate Healthcare As a ... over 30 hours per week and their families, including: Medical , dental, and vision coverage Paid time off and...for patient-facing employees Qualifications Be the Best Territory Operations Director - Home Health RN Registered Nurse You Can Be… more
- Robert Half Accountemps (Long Beach, CA)
- …a claim and assist the team by answering questions and providing support Requirements Medical Claims, Medicare , Medicare Claim, Medicare Advantage, ... in Long Beach is in the need of a Medical Claims Examiner III. This role of Medical...maintains and runs standard reports * Assist the Claims Supervisor/ Director in reviewing the quality auditing tracking/reporting (financial and… more
- Option Care Health (Sun Valley, 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 ... administrator and or alternate director of nursing. **Job Description:** **Job Responsibilities** **(listed... of Nursing of the Home Health Agency for Medicare certified home health agencies in the absence of… more
- WelbeHealth (North Hollywood, CA)
- …WelbeHealth values, team culture, and mission. At the direction of the Medical Director , the Nurse Practitioner works collaboratively with WelbeHealth Physicians ... effective care coordination + At the direction of the Medical Director , review outcomes and utilization data,...enrolled or eligible for enrollment to provide services to Medicare and Medi-Cal participants + Current knowledge of chronic… more
- WelbeHealth (North Hollywood, CA)
- …IDT to develop a care plan for each participant. At the direction of the Medical Director , the Primary Care Physician oversees all care of participants in ... in their homes and in their communities. Our innovative and comprehensive range of medical services to participants is what ignites our passion to treat the whole… more
- Prime Healthcare (Ontario, CA)
- …updates contact files and amends contracts as appropriate for the self-funded medical plan (EPO). Requires a high level of responsibility, confidentiality, judgment ... network. Performs special projects as assigned by the Corporate Director of Employee Health (EPO). * This role is...strong follow-up skills. + Knowledge of CPT, ICD-10 codes, Medicare guidelines, and Managed Care contracts. + Working knowledge… more