- LA Care Health Plan (Los Angeles, CA)
- …Participating Physician Group's (PPG) and Plan Partners' delegated functions, oversees clinical operations for direct lines of business , and interfaces with ... Clinical Operations Executive Job Category: Management/Executive Department: Utilization Management...Director II). The role extends to all lines of business including Medi-Cal, Medicare, and Commercial. This position holds… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Appeals and Grievances General Operations (RN-Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily oversight of...and resolved using regulatory guidance across all lines of business . Provides direct supervision to the A&G clinical team… more
- UCLA Health (Los Angeles, CA)
- …experience; MHA or MBA preferred * Eight or more years of experience performing business operations and financial analysis, including two years in a healthcare ... UCLA Health. As a key member of our Strategic Development & Analytics team, you will lead the analysis...a detail-oriented, self-directed leader with: * Bachelor's Degree in Business Administration, Economics, Finance, Health Care or other related… more
- LA Care Health Plan (Los Angeles, CA)
- …partners. Knowledge and experience with regulatory measures and NCQA standards for Medicaid , Medicare, Marketplace Exchange needed for new development of Quality ... works collaboratively with leadership, management and other stakeholders including Business Owner(s), Investment Review Board, intake and program/project teams and… more
- LA Care Health Plan (Los Angeles, CA)
- …Medi-Cal, Covered California, Cal Medi-connect line of businesses. Contribute to development of business requirements, functional requirements, process flows, ... Preferred Experience Required: At least 5-7 years of related experience relating to Medicare/ Medicaid data operations , encounter data operations . At least… more
- LA Care Health Plan (Los Angeles, CA)
- …and the Care Management vision. This position closely collaborates with business owners, vendors, regulatory body representatives, and other organizational staff to ... understand the business needs for each project and make decisions based...for the department and organization. This position supports the development and implementation of Care Management initiatives to comply… more
- LA Care Health Plan (Los Angeles, CA)
- …of definitive project execution plans. Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions ... as develops full scale project plans utilizing the Systems Development Life Cycle (SDLC) methodology. The Project Manager III...would improve business performance. Consults across business operations… more
- LA Care Health Plan (Long Beach, CA)
- …to the appropriate external resources. Participates in the planning, and development , implementation, and analysis of CRC services, programming, and vendor ... serve as a lead on special projects through the development and implementation of a work plan, technical procedures,...outside of regular operating hours and days based on business needs. Provides support in the creating of child… more
- LA Care Health Plan (Long Beach, CA)
- …external resources. The lead will monitor and assess the planning, development , implementation, and analysis of CRC services, programming, and vendor management. ... The Lead will support manager with immediate urgent decisions for center operations as applicable if manager is not available. Responsible for the daily workflow and… more
- Grifols Shared Services North America, Inc (Los Angeles, CA)
- …**Location:** Southern California, US **Contract Type:** Regular Full-Time **Area:** Sales/Sales Operations Grifols has been a leader in the healthcare industry ... contract management. Position requires strong sales and clinical expertise, business acumen and stakeholder relationships. **Primary Responsibilities for role:**… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Appeal and Grievance Compliance Advisor Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, ... and coverage determination , Appeals and Grievances across all lines of business ). This position is responsible for the ongoing progression and maintenance of… more
- Elevance Health (Woodland Hills, CA)
- …assurance, investigative sufficiency, and case data management; and direction of day-to-day operations as assigned by management. + Through use of appropriate system ... regarding findings. + Assists management and provides recommendation in support of the development of policy and/or procedures to prevent loss of company assets. +… more
- Elevance Health (Woodland Hills, CA)
- …Blue Cross's Medi-Cal Health Plan in CA. The Director oversees marketing-related operations such as direct marketing, product development , agency management, ... an impact:** + Responsible for coordinating and directing the efforts of the Medicaid growth and engagement initiatives + Ensuring marketing plans within the region… more
- LA Care Health Plan (Los Angeles, CA)
- …to comply with State and Federal requirements for all product lines of business ( Medicaid , Medicare, and Commercial). The Account Manager III is responsible ... Provider Network Account Manager III Job Category: Administrative, HR, Business Professionals Department: Provider Network Management Location: Los Angeles, CA, US,… more