- 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
- LA Care Health Plan (Los Angeles, CA)
- Product Solutions Manager III Job Category: Administrative, HR, Business Professionals Department: Medicare Product Location: Los Angeles, CA, US, 90017 Position ... safety net required to achieve that purpose. Job Summary The Product Solutions Manager III is responsible for assisting the product leadership team within the… 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: Administrative, HR, Business Professionals Department: Enterprise Portfolio Management Office Location: Los… more
- Molina Healthcare (Long Beach, CA)
- …**REQUIRED EXPERIENCE:** + 8+ years related experience. + 2+ years in supervisory and/or management experience in Managed Care or Medicare related field. + 3+ ... healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents reports and… more
- LA Care Health Plan (Los Angeles, CA)
- …generally complex and large in scope. In this capacity, the Program Manager works collaboratively with leadership, management and other stakeholders including ... issues for resolution. Accountable for scheduling, cost tracking/budget, resource management allocation and utilization , program component integration and… 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 ... care with internal LA Care departments such as Care Management (CM), Utilization Management (UM),...and identify creative solutions with external agencies. Excellent project management skills. Working knowledge of Medi-Cal and Medicare… more
- Molina Healthcare (Los Angeles, CA)
- …**REQUIRED EXPERIENCE:** + 8+ years related experience. + 2+ years in supervisory and/or management experience in Managed Care or Medicare related field. + 3+ ... healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents reports and… 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
- Elevance Health (Los Angeles, 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 ... who will be responsible for appeals reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director** is responsible for the… 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
- Elevance Health (Los Angeles, CA)
- …on such issues as administrative and medical policy, reimbursement and provider utilization patterns. + Conducts seminars to support the understanding of managed ... resolution through direct contact with providers, claims, pricing and medical management department. + Tracks and conduct provider refresher training. + Researches… more