- Hired by Matrix (Los Angeles, CA)
- …times. Attend and participate in facility meetings as directed by Center Manager (may include utilization review, infection control, disaster preparedness, ... Develops treatment plans, supervises assistants and aides, contributes to case management , and provides quality patient care. Maintains positive level of interaction… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- Guidehouse (Gardena, CA)
- …**What You Will Do** **:** The **Insurance Patient Account Representative - Medicare Emphasis** is an extension of a client's business office staff. Representatives ... from home._** **_Questions regarding this position, you may contact Chris Rivera ( Manager , Talent Acquisition) at ###_** **Essential Job Functions** + Medicare … more
- Bausch + Lomb (Los Angeles, CA)
- …Subject matter expert on Bausch + Lomb's patient support programs, payer utilization management , access issue resolution, financial assistance and Company ... the local and national payer landscape - this includes Specialty Pharmacy and Utilization Management criteria for assigned products. + Manage daily activities… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Enhanced Care Management (RN or LCSW) Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... Job Summary Reporting to the Director of Enhanced Care Management (ECM), the ECM Manager will be...years of leading a process, program or staff or supervisory/ management experience. Experience in Medi-Cal/Medicaid, Medicare , or… more
- LA Care Health Plan (Los Angeles, CA)
- …Collaborates with internal departments (Member Services, Provider Network Operations, Claims, Utilization Management , Pharmacy, and Quality Management ) to ... Manager , Customer Solution Center Appeals and Grievances Job...work collaboratively with multiple departments (Claims, Provider Network Operations, Utilization Management , Quality Management , Pharmacy)… more
- Molina Healthcare (Los Angeles, CA)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... **_This Program Manager supports Medicaid and Medicare Healthcare...management experience in a managed healthcare environment. + Medicaid/ Medicare Population experience with increasing responsibility. + 3+ years… more
- Actalent (Los Angeles, CA)
- …industry leader in a fast-paced environment! Requirements: + CA RN license + Case Management experience + Medicare or Medical experience + Ability to work ... Care Organization is looking for a REMOTE RN Case Manager to join their growing team! Opportunity to make...management systems Skills: Case Management , Care Management , CA RN License, EMR System, Medicare ,… more
- LA Care Health Plan (Los Angeles, CA)
- …operational/functional areas. Responsible for scheduling, cost tracking/budget, resource management allocation and utilization , project component integration ... Portfolio Delivery Project Manager III Job Category: Information Technology Department: Enterprise... III Job Category: Information Technology Department: Enterprise Portfolio Management Office Location: Los Angeles, CA, US, 90017 Position… more
- LA Care Health Plan (Los Angeles, CA)
- …are generally complex and large in scope. In this capacity, the Program Manager will work collaboratively with leadership, management and other stakeholders ... Enterprise Shared Services Program Manager II (Limited Duration- 12 months)) Job Category:...issues for resolution. Accountable for scheduling, cost tracking/budget, resource management allocation and utilization , program component integration… more
- LA Care Health Plan (Los Angeles, CA)
- …Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance Salary Range ... the coordination of member care with internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and… more
- LA Care Health Plan (Los Angeles, CA)
- …departments throughout LAC including but not limited to QI, Pharmacy, Care Management , Utilization Management , Risk Adjustment, Products, Customer Solution ... Clinical Quality Program Manager II (CAHPS) Job Category: Clinical Department: Quality...guiding projects relating to quality excellence in Centers for Medicare and Medicaid Services (CMS) Five-Star Rating System and… more
- LA Care Health Plan (Los Angeles, CA)
- …health care resource utilization . Assures appropriate staff support of Utilization Management and other relevant committees. Supports the maintenance of ... Senior Director, Care Management Job Category: Clinical Department: Care Management...department performs the following: All contracts [(ie Centers for Medicare and Medicaid Service (CMS), California Department of Health… more
- LA Care Health Plan (Los Angeles, CA)
- …acuities or care needs and requiring the highest clinical skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care ... Care Management Specialist II Job Category: Clinical Department: Care...health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health… more
- LA Care Health Plan (Los Angeles, CA)
- …health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management (UM) and so forth) and developing audit ... training programs and making presentations. Preferred: 2 years of Medi-Cal, Medicare or commercial product compliance. Regulatory change management and… more
- Guidehouse (Gardena, CA)
- …systems and billing processes. + The Billing Supervisor reports directly to an Operations Manager or Director level position and may perform any and all related job ... CPT4, HCPCS and Revenue Codes. + Provide departments with Medicare and other payer updates, notices and coverage changes...paper claim report. + Other reports as requested by management . + Weekly report of Late Charge to Departments.… more
- UCLA Health (Los Angeles, CA)
- …closely with interdisciplinary stakeholders across the health system in finance, utilization management , operations, population health, data analytics, nursing, ... Care (MD SC) will be responsible for leading the management and day-to-day oversight of the Senior Care clinics,...Care clinics and will partner with an administrative clinic manager to oversee clinical workflows in the clinics. The… more
- Elevance Health (Woodland Hills, CA)
- …a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid ... to Medical Director Associates. Works independently with oversight from immediate manager . May be responsible for an entire clinical program and/or independently… more