Operations Specialist III – Medicaid / Medi-Cal (Epic + Utilization Review

Immediate need for a talented Operations Specialist III – Medicaid / Medi-Cal (Epic + Utilization Review. This is a 06+months contract opportunity with long-term potential and is located in Long Beach, CA(Remote). Please review the job description below and contact me ASAP if you are interested.Job ID: 26-02810Pay Range: $30 - $45/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)Key Responsibilities:Medicaid / Medi-Cal Chart ReviewPerform comprehensive health chart and administrative chart reviewsEnsure documentation completeness and regulatory complianceIdentify and escalate quality or utilization concernsSupport Medicaid program performance metrics and reportingUtilization Review & AuthorizationsConduct Utilization Review activitiesSupport authorization workflows and payor processes (Anthem, Blue Shield, etc.)Review medical necessity documentationCollaborate with clinical and administrative teams to resolve discrepanciesEpic & Workflow ExecutionNavigate and abstract data within Epic (HealthConnect preferred)Manage assigned review queues and documentation workflowsTrack operational performance metricsSuggest workflow improvements where applicableOperational & Process SupportAssist in centralizing and refining hospital/system-wide workflowsSupport productivity standards and cost-reduction initiativesContribute to operational efficiency and sustainability projectsSchedule: 8:00 AM – 4:30 PM5 days/week including every other weekend (Saturday & SundayKey Requirements and Technology Experience: 1–2+ years healthcare operations experience (3–5 years ideal)Strong Medicaid / Medi-Cal backgroundExperience with Epic EHR (Kaiser HealthConnect highly preferred)Utilization Review exposure (authorization workflows, Tapestry preferred)Experience conducting chart reviews (clinical or administrative)Ability to work independently post-trainingStable healthcare employment historyEducation: High School Diploma required; Associate or Bachelor’s degree preferred.Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.