Utilization Management Policy Initiatives Registered Nurse Macpower Digital Assets Edge Private LimitedUtilization Management Policy Initiatives Registered NurseLos Angeles, CARemote$102,183–$132,838 / yearThis role ensures that the day to day functions of Utilization Management initiatives comply with regulatory and accreditation requirements such as those stated in contracts, CalAIM Population Health Management (PHM) Policy Guide, National Committee on Quality Assurance (NCQA) Department of Health Care Services (DHCS) All Plan Letters (APLs), and Centers for Medicare and Medicaid Services (CMS) Model of Care (MOC) through sound clinical policy maintenance. Non-negotiable requirements of this position: Direct past experience with Health Care / Medical Policy work specifically within a Managed Care Plans environment; experience with the ongoing development of the Medical Policy review process including clinical and utilization data analysis; Assisted in developing training documents and presentations for new and/or revised Medical Policies to internal stakeholders.
NewSIU Investigator Centene Corporation GroupSIU InvestigatorCA$56,200–$101,000 / yearLicenses/Certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred. Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts.
Medical Billing Customer Representative UCLA Health SystemMedical Billing Customer RepresentativeLos Angeles, CA$30.79–$40.60 / hourAs a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. We're seeking detail-oriented, self-directed professional with: REQUIRED - Two years recent professional billing collection experience as well as two years of customer service experience.
Collections Representative Government Billing SGA Inc.Collections Representative Government BillingLos Angeles, CA$20–$27 / hourResponsibilities : The Collections Representative – Government Billing is responsible for the accurate and timely billing of inpatient, outpatient, and laboratory claims to government and third-party payers. Software Guidance & Assistance, Inc., (SGA), is searching for a Collections Representative – Government Billing for a Contract assignment with one of our premier Healthcare clients in Los Angeles, CA.
NewSr. Coordinator, Individualized Care (Case Manager) Cardinal Health IncSr. Coordinator, Individualized Care (Case Manager)CA$21.40–$30.60 / hourDelivering an exclusive model that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Cardinal Health, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, and support organizations to facilitate coverage and delivery of product in a timely manner.
Strategic Client Manager CPSIStrategic Client ManagerCAThis role owns client-specific success and recovery plans, drives measurable improvements across the revenue cycle and broader solution portfolio, coordinates cross-functional execution, manages escalations and risk, supports retention and growth, and ensures clients can demonstrate value from the TruBridge partnership. Maintain a disciplined client risk management process using service, financial, operational, relationship, and contractual indicators; identify emerging risks early; quantify retention and financial exposure; establish mitigation plans with accountable owners and deadlines; and escalate unresolved risks through measurable resolution.
Gastroenterologist - Long Beach, CA UnitedHealth Group IncGastroenterologist - Long Beach, CALong Beach, CAClinical › Corporate and business operations › Customer and support services › Early careers› Sales and account management › Technology and data› Physicians› Advanced practice clinicians› Pharmacy› Behavioral health› Nursing› Medical coding› Clinical support› U.S. › Ireland & UK › India › Philippines › Culture of Belonging› Employee Benefits› Blog. Technology and data Artificial intelligence Architecture Business systems analysis Data analytics Data engineering Data science Network infrastructure Product management & development Security and risk Software engineering.
Medical Assistant, Care Connections - CA ONLY Molina Healthcare IncMedical Assistant, Care Connections - CA ONLYLong Beach, CACoordinates care between members and providers after appointment/service delivery to support member navigation of the health care system, needs related to follow-up care and highest quality care/desired member health outcomes. Responsible for contacting members following appointments/services rendered to ensure member understanding and navigation of the health care system, and coordination support for follow-up care.
Coder City of HopeCoderCAThis role abstracts and codes relevant data elements for a certain type of professional fee service area (i.e., Evaluation & Management, major and minor surgical procedure, radiologic service, pathologic service, ancillary service, radiation oncology, and/or infusion charges) for multi-specialty physicians. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix.
Clinical Documentation Integrity Specialist Adventist Health SystemClinical Documentation Integrity SpecialistLos Angeles, CAJob Summary: Reviews, evaluates and assesses medical records of patients, looks for specificity of an illness, the accuracy of the clinician's documentation, coding requirements and documentation of important medical details to ensure the overall quality and completeness of clinical documentation of the patient medical record and ensure it is in compliance with government and other regulations. Essential Functions: Evaluates and assesses medical records of patients, looks for specificity of an illness, the accuracy of the clinician's documentation, coding requirements and documentation of important medical details to ensure the overall quality and completeness of clinical documentation of the patient medical record.
Senior Physician Assistant - Radiology UCSF Medical CenterSenior Physician Assistant - RadiologyCAKey responsibilities for this role include (but not limited to) the following: Billable inpatient evaluation and management (E&M) services including evaluation of new adult and pediatric inpatient consults, daily rounding on established IR patients, assistance with admission and discharge for primary IR patients and with care coordination for all IR patients across all UCSF campuses. UCSF APPs are expected to demonstrate accountability for their own clinical practice, participate in patient and staff education, serve as resources for APPs, APP students/fellows, physician residents/fellows, nurses and other staff, exhibit leadership skills, and engage in the mentoring of newly hired APPs.
Emergency Department Charger/Coder University of CaliforniaEmergency Department Charger/CoderLos Angeles, CARemote$40.04–$52.83 / hourAs a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. You will assign ICD-10-CM and CPT/HCPCS codes for emergency department patients while ensuring accurate charge assignments using ASAP software within EPIC (CareConnect).
Clinical Documentation Integrity Specialist University of CaliforniaClinical Documentation Integrity SpecialistLos Angeles, CARemote$100,161.36–$218,718 / yearThis role involves daily review of high-acuity patient records to identify potential and active payer denials, assess clinical validity, and to support denial prevention, analysis, and appeals across inpatient and outpatient settings; continuously communicating with department staff; educating physicians, residents, and mid-levels; and assisting with appropriate documentation strategies. You will prepare and submit high quality appeal letters supported by clinical evidence, regulatory guidelines, and payor-specific medical necessity criteria, while identifying denial trends and root causes and provide feedback to the CDI and Clinical teams.
Internal Medicine Physician - Optum - Torrance, CA UnitedHealth Group IncInternal Medicine Physician - Optum - Torrance, CATorrance, CAClinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S. Artificial intelligence Architecture Business systems analysis Data analytics Data engineering Data science Network infrastructure Product management & development Security and risk Software engineering.
Primary Care Physician - South Bay/Torrance - Optum UnitedHealth Group IncPrimary Care Physician - South Bay/Torrance - OptumTorrance, CA$237,361–$331,688 / yearOur Value Based Care model allows our clinicians the time needed to provide quality care to patients while supporting a healthy worklife balance Our model is designed to provide the most efficient comprehensive and proven care techniques to treat the whole patient - physically mentally and socially - at each visit. Clinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S.
Optum CA, Rheumatologist-Pasadena, CA UnitedHealth Group IncOptum CA, Rheumatologist-Pasadena, CAPasadena, CAWhat makes an Optum Career different Be part of a best-in-class employee experience that enables you to practice at the top of your license We believe that better care for clinicians equates to better care for patients We are influencing change collectively on a national scale while still maintaining the culture and community of our local care organizations Practice medicine autonomously with the support not restrictions of a sustainable and thriving national health care organization. Clinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S.
Pharmacy Technician - Full Time UnitedHealth Group IncPharmacy Technician - Full TimeGardena, CAClinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S. Technology and data Artificial intelligence Architecture Business systems analysis Data analytics Data engineering Data science Network infrastructure Product management & development Security and risk Software engineering.
Medical Director, Utilization Management L.A. Care Health PlanMedical Director, Utilization ManagementLos Angeles, CAThis position plays a critical role in the mitigation of Fraud, Waste and Abuse (FWA) and requires proactive analysis of service level utilization data to identify trends, outliers and emerging risk areas and recommend corrective action to minimize utilization variation, prevent improper payments and ensure financial stewardship. Job Summary The Medical Director, Utilization Management provides clinical oversight of authorization decision making and processing, pre and post payment claims review activities, payment integrity clinical validation and program integrity functions.
Clinical Documentation Specialist Guidehouse IncClinical Documentation SpecialistLos Angeles, CA$74,000–$124,000 / yearInitiates compliant physician queries when documentation is confusing, ambiguous, or missing and follows up with MD to seek immediate response to query (utilizing the following AHIMA practice briefs as a guide: "Managing an Effective Query Process," October 2008 and "Guidance for Clinical Documentation Improvement Programs", May 2010). Reviews daily admissions to assigned unit, perform initial code assignment for a working DRG and complete CDI software data entry for initial and follows up case reviews (or worksheet to include code and DRG assignment) and submit to Program Assistant.
NewClinical Documentation Integrity Specialist II - Hybrid FT Days Torrance Memorial Medical CenterClinical Documentation Integrity Specialist II - Hybrid FT DaysTorrance, CaliforniaUses clinical/nursing/coding knowledge to concurrently review and assess the medical record within 24-48 hours of admission including but not limited to physician documentation, lab and radiology results, nursing, nutrition, physical therapy and other provider’s documentation to determine that the most accurate severity of illness and expected risk of morality is reflected in the patient’s health record. Obtains additional documentation from physician or other qualified healthcare provider for clarification when there is conflicting, incomplete or ambiguous information in the healthcare record regarding any reportable data elements dependent on health record documentation.