- Elevance Health (Los Angeles, CA)
- ** Medical Director - Medicare and Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... and skill development. Candidates must live in California. The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market… more
- WelbeHealth (Los Angeles, CA)
- …planning + Assess and refine risk-adjusted revenue projections for Medicare - Medicaid dual-eligible populations, incorporating CMS and state methodologies ... of seven (7) years of actuarial experience, with a strong background in Duals ( Medicare - Medicaid ) or PACE revenue models highly preferred + Two (2) years of… more
- Sunnyside Nursing and Post-Acute Care (Torrance, CA)
- …+ REPORTING REQUIREMENTS: Timely submits required data to the Center for Medicare and Medicaid Services (CMS). + CHART AUDITS/COMPLIANCE: Coordinates monthly ... Records department. Requirements + At least 5 years experience as a Medical Records Director / Health Information Manager of a skilled nursing facility + Skilled… more
- LA Care Health Plan (Los Angeles, CA)
- …(CM). Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM ... Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data… more
- LA Care Health Plan (Los Angeles, CA)
- …Working knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and Knox-Keene requirements, as well ... 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… more
- The County of Los Angeles (Los Angeles, CA)
- …utilized to meet quality and safety standards consistent with the Centers for Medicare and Medicaid Services requirements. Assisting in the management is defined ... (CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In… more
- UCLA Health (Santa Monica, CA)
- …various types of various third party payers (PPO, POS, managed care, Medicare , Medicaid , pre-authorization, pre-certification, workmen's comp, etc.) + Ability to ... Description Under the general supervision of the Operations Manager and Clinical Director , the Ambulatory Care Administration Supervisor 1 oversees daily front desk… more