- Scripps Health (San Diego, CA)
- …coding * Mailroom experience. **Job:** **Finance* **Organization:** **Scripps Health Corp* **Title:** * Director , HMO Claims Services * **Location:** ... have been with Scripps Health for over 10 years. The Director of HMO Payment ( Claims ) Services for Scripps Health Plan, leads claims payment team and… more
- Sharp HealthCare (San Diego, CA)
- …or more years of clinical practice of medicine. + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - ... plan functions that interface with medical management such as provider relations, member services , benefits and claims management, IT management, etc. + Plans,… more
- Emanate Health (Covina, CA)
- … HMO hospital agreement negotiation experience required. Excellent customer service skills required. Delivering world-class health care one patient at a ... Assists with all contracting administration and projects, as assigned. Manages Capitation Claims Operations, staff and vendors including, but not limited to, Health… more
- Providence (Mission Hills, CA)
- **Description** Working under the general supervision of the Claims Director , provide an effective education program to advance the quality and production level ... 5 years experience of acquired in-depth technical knowledge of functional area ie, claims operations, HMO products, industry claims processing procedures,… more
- City of Long Beach (Long Beach, CA)
- …growth in the region. THE ROLE Under the dynamic leadership of the Port's Director of Finance, the Chief Risk Officer (CRO) will spearhead the strategic development ... + Assists the City Attorney's Office with handling of claims + Monitor industry trends, advancements, and best practices...+ Group Health Insurance - Medical and dental options ( HMO and PPO). Free vision coverage. + Life Insurance… more
- LA Care Health Plan (Los Angeles, CA)
- … claims and verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to ... required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by… more
- LA Care Health Plan (Los Angeles, CA)
- …Works with the UM Manager and Physician Advisor on case reviews for pre- service , concurrent, post- service and retrospective claims medical review. Monitors ... requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers,… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Our shared services team offers candidates the opportunity to make a meaningful impact by providing ... and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies… more
- Sutter Health (Castro Valley, CA)
- …patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services , third party payers and review agencies, claims and ... or critical care nursing area may be considered for employment at director 's discretion. + 2 years experience with clinical assessment for patient with… more