- 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
- 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
- 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
- Elevance Health (Los Angeles, CA)
- **Process Improvement Director -Enterprise HEDIS** **Location:** This position will work a hybrid model (remote and office). Must reside within 50 miles/1hour commute ... from an Elevance Health location. The **Process Improvement Director -Enterprise HEDIS** is responsible for identifying opportunities for improvement, developing and… more
- Dignity Health (Los Angeles, CA)
- …Wellness Program. + Paid Time Off (PTO). **Responsibilities** **Position Summary:** As our Director of Security at California Hospital Medical Center, you will ... **Overview** Founded in 1887, Dignity Health - California Hospital Medical Center is a 318-bed, acute care, nonprofit hospital...of Life Safety, The Joint Commission (TJC), Center for Medicare and Medicaid Services (MS) and OSHA regulations and… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at New Century Health Plan. Reporting to the Chief Medical Officer for Medicare Advantage, you will play a crucial role in leading and ... quality improvement experience, with 3-5 years in a leadership role within a Medicare Advantage plan or similar setting + In-depth knowledge of CMS regulations,… 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
- 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
- MetroLink (Los Angeles, CA)
- …support, prepares reports and other information necessary to support the Department Director and the staff. TO APPLY: This is a continuous recruitment, with ... 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
- LA Care Health Plan (Los Angeles, CA)
- … medical necessity reviews. Prepares authorizations, after approval by the Medical Director . When necessary, outreaches to providers, vendors, hospitals, and ... member's satisfaction in a manner consistent with LA Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit coordination may… more
- LA Care Health Plan (Los Angeles, CA)
- …Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data ... ( medical records) and referral requests by Providers. Acts as...reports are maintained and referred to the Physician Advisor/UM Director . Documents in platform/system of record. Utilizes designated software… more
- LA Care Health Plan (Los Angeles, CA)
- …Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data ... ( medical records) and referral requests by Providers. Acts as...reports are maintained and referred to the Physician Advisor/UM Director . Document in platform/system of record. Utilize designated software… more
- Bristol Myers Squibb (Los Angeles, CA)
- …bill therapy reimbursement experience including: + Coverage, coding, billing and payment + Medicare (NCD, IPPS, OPPS, 340B, etc.) + Medical policy, managed care ... within the assigned territory. The CMAM will report into the West Region Director , Cell Therapy Market Access Managers. The individual is required to achieve all… more
- UCLA Health (Los Angeles, CA)
- …Appeals & Grievances team in resolving members' concerns. + Collaborate with medical director in investigating potential quality issues. Salary Range: $129,018- ... Century Health Plan and coordinate the care for our Medicare Advantage members. As a Care Management Nurse, you...care coordination, or a related field. + Experience with Medicare Advantage plans and knowledge of CMS regulations is… more
- LA Care Health Plan (Los Angeles, CA)
- …the Regulatory Compliance unit, the Advisor also advises and supports the Manager, Director , and Chief Compliance Officer on other duties as assigned to support the ... training programs and making presentations. Preferred: 2 years of Medi-Cal, Medicare or commercial product compliance. Regulatory change management and risk… 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