- Scripps Health (San Diego, CA)
- …coding * Mailroom experience. **Job:** **Finance* **Organization:** **Scripps Health Corp* **Title:** * Director , HMO Claims Services * **Location:** ... have been with Scripps Health for over 10 years. The Director of HMO Payment ( Claims ) Services for Scripps Health Plan, leads claims payment team and… more
- Sharp HealthCare (San Diego, CA)
- …or more years of clinical practice of medicine. + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - ... plan functions that interface with medical management such as provider relations, member services , benefits and claims management, IT management, etc. + Plans,… more
- Touro University (Hawthorne, NY)
- …role in its future success. Reporting to the Chief Development Officer, the Director of Advancement Services will provide the technical expertise, oversight, ... is looking for an accomplished and creative professional to manage the advancement services group and be an instrumental agent for growth and change. The Department… more
- Molina Healthcare (Long Beach, CA)
- …policies and procedures that guide and support the provisions of medical staff services . Maintains a working knowledge of applicable national, state, and local laws ... oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction… more
- Sharp HealthCare (San Diego, CA)
- …the requested service . This position is responsible for conducting retrospective claims review for services to determine the medical appropriateness of the ... etc. + Retrospective Review Coordinate, review, and process retrospective claims for medical care and services including,...at the UM Care Coordinator level of review.Appropriately identify claims for review by the Medical Director … more
- MetroLink (Los Angeles, CA)
- …information technology, operations, maintenance, architectural and engineering, and professional services . TO APPLY: This is a continuous recruitment with the ... duties. SUPERVISION EXERCISED AND RECEIVED + Receives supervision from Director , Senior Manager, and Manager II roles. + The...compliance. + Assist in developing strategies to avoid risk, claims , damages, and impact to schedule. + Work with… more
- McLaren Health Care (Flint, MI)
- …utilization patterns for identification of high risk, and under and overuse of services . Collaborates with Medical Director and senior management on complex ... join us in leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren Health Care...leaders in driving the organization forward and delivering quality service to all our members. McLaren Health Plan is… more
- Johns Hopkins University (Middle River, MD)
- …analysis, consultation, and reports to the Department Administrator and the Senior Director of Revenue Operations Physicians Billing Service (PBS). Reviews ... if needed. + Provide assistance to the Department Administrator and the Senior Director of Revenue Operations Physicians Billing Service (PBS) in the form… more
- LA Care Health Plan (Los Angeles, CA)
- …Works with the UM Manager and Physician Advisor on case reviews for pre- service , concurrent, post- service and retrospective claims medical review. Monitors ... requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers,… more
- Sutter Health (San Francisco, CA)
- …patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services , third party payers and review agencies, claims and ... Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN...observation status. + Some awareness of healthcare reimbursement systems: HMO , PPO, PPS,CMS preferred. + Post-acute levels of care… more