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Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor.
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Promotes compliance with and adheres to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies' standards such as the National Committee for Quality Assurance (NCQA) as it relates to care coordination activities.
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Managed by Oakmont Management Group,we provide exceptional quality, comfort, and care with five-star services and amenities. Prefer one (1) year of experience assisting with medications at a Residential Care Facility for the Elderly (RCFE.
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Forwards information to Hospital Managed Care Coordinator and contacts patients to schedule and/or confirm appointment, when necessary. Receives approved authorization and referrals from Hospital Managed Care Coordinator and contacts patients to schedule and or confirm appointments.
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They have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities.
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Positions: Concierge- Part Time Only. OMG serves thousands of seniors across communities in California, Nevada, and Hawaii. At OMG, we strive to create an atmosphere of family and community among team members, residents, and resident family members.
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Deep understanding and experience with behavioral health strategy and operations in a managed care setting. Access : Ensure Humana members with behavioral health needs have access to appropriate and high-quality behavioral health care by optimizing network design, benefit design, care management, and referral pathways.
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Understanding of claims processing rules, managed care benefits, and adjudication. Experience in managed care business (HMO) is preferred. Ensure quality processing of various types of claims (e.g., in/outpatient hospital claims, Medi-cal, Commercial, and Medi-care claims.
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Understanding or familiarity with managed care or population health management principles and reimbursement mechanics. We're going beyond basic care to health programs integrated across the entire continuum of care.
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We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities.
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Must understand the California managed care market, with knowledge of group underwriting or provider contracting principles a plus. Must understand the California managed care market, with knowledge of group underwriting or provider contracting principles a plus.
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Compassionate Cancer Care Medical Group is seeking an experienced BC/BE Hematologist/Medical Oncologist to join our extensive, well-established, physician-led , and managed group practices situated in Los Alamitos , CA.
$400,000 - $450,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Identify and develop business relationships with key customers, state and local advocacy groups, teaching institutions, key influencers/prescribers, and managed care organizations and establish oneself as a true diabetes/endocrine expert and resource.
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The firm’s range of expertise includes many related legal fields including medical malpractice, business litigation, health care law, legal malpractice defense, product liability and managed care issues.
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Familiarity and knowledge of authorization process & managed care programs. Major duties include but are not limited to: acting as a liaison for the patients and physicians in the practice, assisting patients in accessing service within the health system, facilitating communication with referring physicians, referring patients to appropriate resources and providing follow-up through telephone and EPIC/Care Connect.
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managed care jobs in Long Beach, CA
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