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Experience as a case manager or discharge planner interacting with managed care payers. Knowledge of managed care and Health Plan contracts. To provide discharge planning and coordination of care for members hospitalized in the acute care setting in collaboration with the Hospitalist team, SRS primary care physician, and ancillary staff to ensure cost effective quality service throughout the continuum of care.
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Stays current on Medi-cal, Medicare, MSN, Covered California, COBRA, limited benefit plans, Worker’s Compensation and Financial Assistance.
$24.58 - $37.05 an hour depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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All clinical & state regulatory supervision of support teammates (PTA) are to be directly managed with direct support from their Clinic Manager (CM), Regional Clinic Manager (RCM) & Director of Clinical Operations (DCO.
$40.87 - $60.1 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Strong knowledge and understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines. Experience with Medi-Cal, Commercial, and Medicare Managed Care Plans and / or sales, customer service, or membership and eligibility.
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EDUCATION, TRAINING, EXPERIENCE:Minimum Bachelors degree from accredited University, Masters preferredValid CA clinical license; RN, LCSW, PsyD, NPMinimum 10 years management role Managed Care Environment, preferably in Behavioral health.
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Knowledge of general claims processing principles, CMS claims coding, and UB-04 claims coding, based on at least three to five (3-5) years experience in claims processing preferably in a managed care environment (IPA,MSO) Req. Certification/Licensure: None.
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1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience strongly preferred. Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.
$28ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Experience: 7+ years of SQL development (flexible) 3+ years of healthcare managed care experience 3+ Experience in data integration within the Healthcare Provider and Managed care space Specialized Abilities: Advanced SQL Server with demonstrated capability using PL/SQL. Experience working with Healthcare Provider and Managed care data from a data profiling, analysis, and modeling perspective, with a solid understanding of the relevant Healthcare business processes.
$30 - $45 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Required qualifications: Masters degree in Social Work (MSW), Psychology, counseling or equivalent human services graduate degree2+ years of experience in a Social Work related role Preferred qualifications: Experience in a skilled nursing facility or palliative careCase management experienceExperience in managed care California Residents Only: The salary range for California residents is $56, to $, per year.
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Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. OMG serves thousands of seniors across communities in California, Nevada, and Hawaii.
$16 - $18 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required. Seeking a highly motivated an experienced TEMP - Claims Resolution Specialist (Customer Service) to join our team.
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Processes authorization for consults and procedures on both fee-for-service as well as managed care patients. 1+ years of experience in outpatient health care system(s) including managed care.
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OCWH offers clinic and office location throughout Southern CA. These facilities ensure that managed care members, the ambulatory population, and those who prefer traditional office visits receive all our services with the additional option of hyperbaric oxygen therapy when called for.
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Member Service RepresentativeHealthCare Support is actively seeking a Member Service Representative to fill an opening with a Managed Care Company in Orange, CA. This is an onsite role, required office hours M-F working any 8 hour shift between 8am-7pm PST. 6 months contract Daily Responsibilities for Member Service Representative: Will be the first line of contact for the health plan’s members and providers.
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Fundamental to your role will be the engagement in, and management of, each child’s plan and ensuring these plans are managed with the highest standards of care and professionalism. Our home in Irvine is recruiting for a Senior Support Worker now.
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managed care jobs in Irvine, CA
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