- Molina Healthcare (Long Beach, CA)
- … director , and quality improvement staff. Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. Reviews quality referred ... relevant experience, including: 2 years previous experience as a Medical Director in a clinical practice. Current...without restrictions to practice and free of sanctions from Medicaid or Medicare . PREFERRED EDUCATION: Master's in… more
- Molina Healthcare (Long Beach, CA)
- …prompt and appropriate outreach and coordination of services, including MTM services for Medicare and Medicaid eligible members as well as Medication Adherence ... Preferred Education Ambulatory Care Residency Preferred Experience Experience with Medicaid and/or Medicare programs. Preferred License, Certification,… more
- Molina Healthcare (Long Beach, CA)
- …State (NM) Medical License without restrictions (free of sanctions from Medicaid or Medicare ) Preferred Education Master's in business administration, Public ... including: Minimum 5 years clinical practice. 5 years in a Medical Director role. 4 years HMO/Managed Care experience, including Utilization and/or Quality… more
- APLA Health (Los Angeles, CA)
- …current ICD and CPT coding Healthcare billing processes and insurance plans ( Medicaid , Medicare , and private/commercial plans; including dental and/or mental ... 8am - 5pm Description POSITION SUMMARY: Under the direction of the Clinic Director II, the Clinic Manager, GCHC-Annex is responsible for the coordination and… more
- 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 ... required by law. **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 ... department. Requirements + At least 3-5 years of experience as a Medical Records Director / Health Information Manager of a skilled nursing facility + Skilled… more
- Providence (Santa Monica, CA)
- …just awarded a 5-star rating for quality, safe care from the Centers of Medicare and Medicaid Services (CMS). Under the general supervision of the Administrative ... **Description** Medical Laboratory Scientist at Providence Saint John's Health... Director of the Laboratory, performs accurate analysis of laboratory… more
- LA Care Health Plan (Los Angeles, CA)
- …the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… 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
- Molina Healthcare (Los Angeles, CA)
- …experience with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not ... Operating Committees, and delegation oversight. * In conjunction with Director , Provider Contracts, develops health plan-specific provider contracting strategies… 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
- Cedars-Sinai (Los Angeles, CA)
- …, the coordination of efforts for Department of Health Services, Center for Medicare and Medicaid Services, and The Joint Commission accreditation as it ... Hospitals" Honor Roll. As a full time Business Continuity Manager at Cedars-Sinai Medical Center in Los Angeles, California, you will lead all aspects of business… more
- Providence (Santa Monica, CA)
- …just awarded a 5-star rating for quality, safe care from the Centers of Medicare and Medicaid Services (CMS). Under the general supervision of the department ... Director , this position will coordinate administrative functions of the...401(k) Savings Plan with employer matching, health care benefits ( medical , dental, vision), life insurance, disability insurance, time off… more
- Molina Healthcare (Long Beach, CA)
- …familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not ... Tighter knit proximity ongoing after contract. * In conjunction with Director /Manager, Provider Contracts, negotiates Complex Provider contracts including but not… 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
