- 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
- Cedars-Sinai (Los Angeles, CA)
- **Job Description** The Medical Director of Mental Health is a psychiatrist who oversees mental health services in the Medical Network and provides support ... mental health needs of patients cared for across the Medical Network. The Medical Director ...including maintaining the network of providers for the CSMN Medicare Advantage plan(s). + Assists Contracting with identification, engagement,… more
- MetroLink (Los Angeles, CA)
- Assistant Director , Finance (Grants) Print (https://www.governmentjobs.com/careers/scrra/jobs/newprint/4648818) Apply Assistant Director , Finance (Grants) ... OF POSITION Metrolink is seeking a highly skilled Assistant Director , Finance to join our Finance team. The Assistant...employer. The SCRRA is an Equal Opportunity Employer. EEO/ADA MEDICAL : SCRRA offers a choice of twelve (12) health… more
- UCLA Health (Los Angeles, CA)
- …health organization. Help drive the delivery of high-quality, cost-effective care for Medicare Advantage members. Take your expertise to new levels. You can do ... at New Century Health Plan. Reporting to the Chief Medical Officer, you will play a pivotal role in...clinical efforts to optimize care delivery and outcomes for Medicare Advantage members. You will: + Provide clinical leadership… 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
- Providence (Santa Monica, CA)
- …line through strategic plans/policies, in collaboration with CMO, Administrative Director , Safety and medical /program directors. Implements strategies that ... **Description** **THE ROLE** The Director , Case Management promotes and supports the mission,...in addition to providing education on continual changes in Medicare regulation and reimbursement. + Form positive relationships with… more
- LA Care Health Plan (Los Angeles, CA)
- …and motivating direct-reports. Duties General Essential functions: Collaborating with the Medical Director , responsible for the operations, programming and ... LA Care members healthy and access appropriate services. The Director will also work with the CM Medical...department performs the following: All contracts [(ie Centers for Medicare and Medicaid Service (CMS), California Department of Health… more
- Bayer (Los Angeles, 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
- WelbeHealth (Los Angeles, CA)
- …program helps seniors stay in their homes and communities by providing all-inclusive medical care and community-based services. It's our mission to serve the most ... model. As a member of the Outreach & Enrollment team, the Director , Independent Channels drives the recruitment, training, production, and compensation for brokers… more
- LA Care Health Plan (Los Angeles, CA)
- Associate Counsel III Senior Director Health Care Legal Services Job Category: Management/Executive Department: Health Care Legal Services Location: Los Angeles, CA, ... to achieve that purpose. Job Summary The Associate Counsel III Senior Director Health Legal Services is responsible for diverse legal activities. This position… more
- Elevance Health (Los Angeles, CA)
- **Government Business Quality Management Health Plan Director -California** **Location** : This position will work a hybrid model (remote and office). The ideal ... Elevance Health PulsePoint location. The **GB Quality Management Health Plan Director ** is responsible for driving the development, coordination, communication, and… more
- Gilead Sciences, Inc. (Los Angeles, CA)
- …the lives of patients with life-threatening illnesses worldwide. As the **Senior Director , Field Reimbursement Management (FRM)** for HIV Prevention, you will play a ... with pharmacy benefits, specialty payer landscape, and reimbursement pathways (commercial, Medicare , Medicaid). + An understanding of local and state policy changes'… more
- UCLA Health (Los Angeles, CA)
- …this and more at UCLA Health New Century Health Plan. Reporting to the Chief Medical Officer of Medicare Advantage, you will play a pivotal role in overseeing ... the development, evaluation, and implementation of clinical programs that are vital to our mission. You will: + Lead and manage multiple clinical programs + Drive the execution of population health management initiatives + Ensure alignment of clinical services… 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
- MetroLink (Los Angeles, CA)
- …job series. SUPERVISION EXERCISED AND RECEIVED + Receives general oversight from director or executive level roles. + Responsible for supervising and monitoring ... management system rehabilitation programming, under the direction of the Director , State of Good Repair. + Serve as the...employer. The SCRRA is an Equal Opportunity Employer. EEO/ADA MEDICAL : SCRRA offers a choice of twelve (12) health… 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
- MetroLink (Los Angeles, CA)
- …or supervisor duties. SUPERVISION EXERCISED AND RECEIVED + Receives supervision from Director , Senior Manager, and Manager II roles. + The position may supervise ... employer. The SCRRA is an Equal Opportunity Employer. EEO/ADA MEDICAL : SCRRA offers a choice of twelve (12) health...exceeds $50,000, be added to your Federal, State, and Medicare taxable earnings for W-2 reporting. This amount is… more
- UCLA Health (Los Angeles, CA)
- …and that clear, timely communication is provided to all stakeholders + Working closely with medical director and appeal & grievance team to ensure that all cases ... appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid Services) regulations for Medicare ...for Medicare & Medicaid Services) regulations for Medicare Advantage plans + Ensuring that all cases are… more
- LA Care Health Plan (Los Angeles, CA)
- …Department of Health Care Services (DHCS) All Plan Letters (APLs), and Centers for Medicare and Medicaid Services (CMS) Model of Care (MOC). This position is a role ... leadership team. Accountability: Assume ownership under direction of the department Director or Senior Director , for successful development, planning, and… more
- LA Care Health Plan (Los Angeles, CA)
- …the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more