- Kaiser Permanente (Oakland, CA)
- …capabilities into powerful solutions, your expertise helps shape the future of health care. Regional Director Medi - Cal Pediatrics and Other Special ... strategic importance to the company. You will lead the regional CCS program and the Medi - Cal...Clinical Decision Unit and will report to the Executive Director of Medi - Cal Strategy and… more
- Partnership HealthPlan of California (Eureka, CA)
- …abilities. Special Skills, Licenses and Certifications Comprehensive knowledge of California's Medi - Cal program. Strong customer service orientation; ability to ... POSITION PURPOSE Under the direction of the Northern Region Executive Director , this position is responsible for the planning, direction, implementation, and… more
- Necnic Group, LLC (Fresno, CA)
- …physician jobs brought to you by DocCafe.com California - Fresno, CA - Regional Medical Director Position Purpose: Build creditable and trusting relationships ... liaison between the Health Plan and Medical Groups. There is opportunity for growth and the business develops in the commercial, Medi - Cal and Medicare markets. more
- Central California Alliance for Health (Merced, CA)
- …evaluation, analysis, and reporting Healthcare industry and healthcare planning California Medi - Cal program and entitlement programs Tools and techniques of ... and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve approximately 350,000 members in Santa Cruz, Monterey and… more
- Dignity Health (Redlands, CA)
- …Other benefits include Paid Time Off and Sick Leave. **Responsibilities** The Regional Medical Director is responsible for providing clinical expertise and ... and risk-based + physician and hospital payment methodologies. + Knowledge of Medi - Cal and Medicare programs. + Ability to identify healthcare needs of enrolled… more
- Providence Health & Services (Santa Rosa, CA)
- …Operations to oversee the financial affairs of the Napa County Ministry. The Director of Financial Operations directly assists the Regional CFO with the ... **Description:** **Providence St. Joseph Health is calling a Director of Financial Operations to our location in...knowledge of financial effects and reporting requirements of Medicare, Medi - Cal and health plans, as well as… more
- St. Joseph Health / Covenant Health (Napa, CA)
- …Operations will oversee the financial affairs of the Napa County Ministry. The Director of Financial Operations directly assists the Regional CFO with the ... leader to join our team as a Financial Operations Director !** **Job Summary:** The Director of Financial...knowledge of financial effects and reporting requirements of Medicare, Medi - Cal and health plans, as well as… more
- Dignity Health (Glendale, CA)
- …HEALTH. The contracts include such payer entities as HMO's (various products: MA, Medi - Cal , Duals, Commercial), and various risk bearing organizations such as ... timely/accurate dashboard reports, financial reports, risk pool settlements, etc. Director of Risk Contracting establishes priorities of effective risk pool… more
- LA Care Health Plan (Los Angeles, CA)
- …management/supervisory experience and relevant health plan experience. Experience with Medi - Cal and Medicare populations and regulatory requirements. Preferred: ... Case Management, Care Coordination, and Special Programs (ie CCS, Regional Center) functions. Assures departmental compliance with: All contracts...Experience with Medi - Cal , under-served and culturally diverse populations. Experience… more
- The County of Los Angeles (Los Angeles, CA)
- …vision of Whole Person Care - Los Angeles is to ensure the the most marginalized Medi - Cal beneficiaries in the County have the resources and support they need to ... develop the foundational infrastructure necessary to deliver seamless, coordinated services to Medi - Cal populations. The 15 WPC-LA programs will serve high-risk… more
- Centene Corporation (Rancho Cordova, CA)
- …website, database and benefit maintenance Maintenance of prior authorization database files Medi - Cal DMR processing Assist with SHP clinical projects Assist with ... Medi - Cal prior authorizations Oversight and Audit Support...problems or issues. May consult with Clinical Pharmacists or Regional Medical Director on related issues. Education/Experience:… more
- Mercy Medical Center Clinton (Columbus, OH)
- …initiating corrective action as needed. Maintains current knowledge of Medicare, Medi - Cal , Medicaid, and Managed Care billing compliance guidelines and ... of this position. This position reports to the Payment Resolution Director . **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and demonstrates the Trinity… more
- Trinity Health (Columbus, OH)
- …initiating corrective action as needed. Maintains current knowledge of Medicare, Medi - Cal , Medicaid, and Managed Care billing compliance guidelines and ... of this position. This position reports to the Payment Resolution Director . **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and demonstrates the Trinity… more
- Tenet Healthcare (Palm Springs, CA)
- …and Reimbursement Demonstrates knowledge of third party payor system including Medicare, Medi - Cal , commercial, PPO and HMO systems and assists with financial ... The Office Coordinator, under the direction of the Program Director , is responsible for day to day administrative functions of the Wound Care Center including but… more
- The County of Los Angeles (Los Angeles, CA)
- …DESIRABLE QUALIFICATIONS: + Computer literacy (Word, Excel, Access) + Knowledge of Medi - Cal Eligibility Determination System (MEDS) + Knowledge of Children's ... + Process subpoena requests for medical records; SSI requests for records, Regional Center requests for records, etc + Process medical/financial appeals and compile… more
- Numotion (Cerritos, CA)
- …coverage problems regarding reimbursement and payer processes and understands the impact of Medi - cal program changes on Managed Care payers. + Develop and ... to gather leads + Identifies and collaborates with the Director of Payer Contracting to create proposals and execute...overall CRT industry + Build internal relationships with the Regional Billing Center (RBC) and Document Funding Center (DFC)… more
- DaVita Medical Group (El Segundo, CA)
- …research and complete retrospective clinical claims review for Commercial, Senior and Medi - Cal products. Reviews healthcare claims using clinical background and ... to discuss the appropriate disclaimers and appeals process. + Engages regularly with regional Care Management team and Medical Director to discuss ongoing… more
- PIH Health (Whittier, CA)
- …administering care. * Able to demonstrate knowledge of third party, Medicare and Medi - Cal regulations governing home health and hospice. Required Experience * A ... Job Description We're a nonprofit, regional healthcare network with two hospitals, numerous outpatient...professional Clinical Manager who, under direction of the Clinical Director , supervises, plans, and organizes the delivery of home… more
- DaVita Medical Group (El Segundo, CA)
- …clinicians with sanctions or accusations by the Medical Board and notifies the Regional Medical Director and the Credentialing committee chair of any new ... and knowledge of current regulatory and rules around Medicare and Medi - Cal applications, hospital applications and ancillary clinician application requirements.… more
- PIH Health (Whittier, CA)
- …policies and protocols. * Knowledge of managed care payment requirements and Medi - Cal and Medicare requirements. Required Experience * Current California license ... Job Description We're a nonprofit, regional healthcare network with two hospitals, numerous outpatient...be responsible for additional duties as assigned by the Director , including but not limited to clinical supervision for… more
