- Clever Care Health Plan (Huntington Beach, CA)
- …the supervision of the Vice President of Operations, the Credentialing Specialist supports all credentialing operations, including direct monitoring of the delegated ... CMS, NCQA, and internal quality standards. In addition, the Credentialing Specialist will conduct Facility Site Reviews (FSRs), manage credentialing committee… more
- UCLA Health (Los Angeles, CA)
- …support UCLA Health's commitment to accuracy and quality in claim processing. As an Audit and Appeals Specialist , you will: + Facilitate responses to regulatory ... relevant systems, distributing requests to necessary teams + Monitor audit response and appeal statuses, tracking cases...necessary teams + Monitor audit response and appeal statuses, tracking cases and maintaining updated records in… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/ appeal requests, and prepares UM Activity and Weekly Compliance… more
