- 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
- 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