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.
Utilization Management Nurse, Senior- Medicare Concurrent Review Blue Cross and Blue Shield AssociationUtilization Management Nurse, Senior- Medicare Concurrent ReviewLong Beach, CARequires a current California RN License Requires at least 5 years of prior relevant experience Requires strong communication and computer navigation skills Desires strong teamwork and collaboration skills Requires independent motivation and strong work ethic Requires strong critical thinking skills Hybrid Virtual Work This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need. Your Work In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC and CMS evidenced based guidelines, policies and nationally recognized clinal criteria for BSC Medicare line of business.
NewBehavioral Health Utilization Mgmt Clinician, Senior Blue Cross and Blue Shield AssociationBehavioral Health Utilization Mgmt Clinician, SeniorLong Beach, CAIn this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business.
Associate Director, Pharmacovigilance Operations CG Oncology IncAssociate Director, Pharmacovigilance OperationsCARemoteAt CG Oncology, we are building a community of intelligent and passionate team members that share our Vision, Mission and Values, and while the biotechnology space can feel limited in BIPOC, non-binary and even female representation, we endeavor to make hiring decisions that will continue to grow and support our team in the direction of maintaining cultural diversity and sustainability. CG Oncology offers very competitive and comprehensive Total Rewards, helping to support and reward our global team of high-performing employees focused on developing bladder-saving therapeutics for patients afflicted with bladder cancer.
Sr. Marketing, Manager - Recell Avita Medical LimitedSr. Marketing, Manager - RecellIrvine, CA$165,000–$180,000 / yearKey responsibilities include developing the annual brand plan, overseeing the creation of compelling brand assets, designing sales enablement tools, executing demand generation campaigns, supporting field events, and gathering and sharing actionable commercial insights. This role will also support long-term planning by identifying emerging market trends, understanding the evolving needs of customers and the sales team, and translating those insights into impactful marketing strategies.
Nurse Practitioner / Physician Assistant, Adult Medicine Tiburcio Vasquez Health Center IncNurse Practitioner / Physician Assistant, Adult MedicineCA$69.39–$87.91 / hourFederal and State Loan Programs: TVHC is designated as both a Medically Underserved Area (MUA) and a Health Professional Shortage Area (HPSA), making employees eligible to apply for the National Health Service Corps (NHSC) and other federal and state loan repayment and forgiveness programs available to qualifying healthcare professionals. Performs health assessments, including a thorough history and physical examination, ordering or performing certain diagnostic tests, medication orders, evaluation of psychosocial and family aspects of the situation sufficient to make a general health assessment, and diagnose the nature of common acute and chronic conditions, and any necessary follow-up care.
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.
NewSenior Manager, Clinical Data Analytics Edwards LifesciencesSenior Manager, Clinical Data AnalyticsIrvine, California$139,000–$196,000 / yearWorking knowledge of cloud-hosted data architectures (AWS preferred) and data lake concepts (ingestion, ETL/ELT, data cataloging) sufficient to partner effectively with engineering teams — not expected to build pipelines personally, but must be able to translate business/safety requirements into technical specs and validate outputs. Identify issues and collaborate with appropriate team members to bring to resolution; determine root cause; recommend and lead the implementation of corrective actions, complex process development and process improvement solutions to optimize strategic imperatives.
Advanced Practice Provider (App), Nurse Practitioner (Np) Or Physician Assistant (Pa) COPE Health SolutionsAdvanced Practice Provider (App), Nurse Practitioner (Np) Or Physician Assistant (Pa)Los Angeles, CA$150,000–$200,000 / yearComprehensive AWV & Gap Closure: Perform Medicare Annual Wellness Visits in the home, completing detailed cognitive screenings, fall risk assessments, and personalized prevention plans while closing active quality care gaps and appropriately capturing HCC codes as part of documentation. This role executes in-home Annual Wellness Visits (AWVs), manages complex clinical transitions of care (TOC) immediately following hospital discharge, and provides long-term stabilization for high-acuity patients enrolled in Complex Care Management (CCM) and is proficient at HCC coding and medical disease documentation.
Trauma Program Coordinator - Trauma Service - F/T - Days University of California, IrvineTrauma Program Coordinator - Trauma Service - F/T - DaysOrange, CaliforniaFull timeAs Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center , American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. *Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional 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; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.
Physical Therapist Center Therapy Director ConcentraPhysical Therapist Center Therapy DirectorLos Angeles, California$95,000–$130,000 / yearThis position is eligible to earn a base compensation rate in the state range of $95,000 to $130,000 annual salary depending on job-related factors as permitted by applicable law, such as level of experience, geographic location where the work is performed, and/or seniority. Masters use of clinical systems to ensure efficient and excellent supportive documentation, appropriate and optimal coding levels, charge capture, and follow-through on all patient care orders.
NewSenior Clinical Research Associate - West Coast/Oncology SystimmuneSenior Clinical Research Associate - West Coast/OncologyLos Angeles, CAFull timePrepare the study reference manual, including liaising with the Contract Research Organization (CRO) team (i.e., central lab, specialty labs and vendors) to ensure efficient preparation and delivery of study materials to investigator sites. CRA is responsible for the management and oversight of their assigned clinical study sites to ensure data quality and patient safety in accordance with ICH-GCP guidelines, local regulations, and applicable SOPs.
Outpatient UM Coordinator MedPOINT ManagementOutpatient UM CoordinatorSherman Oaks, CAFull timeMedPOINT Management is a leading Independent Practice Association (IPA) management company based in Sherman Oaks, CA, providing comprehensive administrative and managed care services to physician networks across Southern California. MedPOINT Management is looking for a dedicated Outpatient Utilization Management Coordinator to join our team in Sherman Oaks, CA.
Quality Analyst Home Health, Lead Assistant Manager ExlService Holdings IncQuality Analyst Home Health, Lead Assistant ManagerCA$60,100–$98,700 / yearContinuous Improvement/Education actively participates with team to ensure alignment and sustained results; attends training (assigned or self-initiated) to improve performance or capitalize on new overpayment trends; keeps up with CMS, OIG, and other publications related to our business. EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates.
Financial Clearance Specialist III - Prearrival - Full Time 8 Hour Rotating (Non-Exempt) (Non-Union) University of Southern CaliforniaFinancial Clearance Specialist III - Prearrival - Full Time 8 Hour Rotating (Non-Exempt) (Non-Union)Los Angeles, CA$26–$41.28 / hourWhen extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. As a leading academic medical center, hundreds of clinical trials are currently taking place at Keck Hospital and its affiliated research institutions, giving patients access to novel and promising therapies that are generally not available elsewhere.
Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Rotating (Non-Exempt) (Non-Union) University of Southern CaliforniaFinancial Clearance Specialist III - PreArrival - Full Time 8 Hour Rotating (Non-Exempt) (Non-Union)Los Angeles, CA$26–$41.28 / hourWhen extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. As a leading academic medical center, hundreds of clinical trials are currently taking place at Keck Hospital and its affiliated research institutions, giving patients access to novel and promising therapies that are generally not available elsewhere.
Sr. Marketing, Manager - RECELL Avita Medical Limited (Registered office)Sr. Marketing, Manager - RECELLIrvine, CA$165,000–$180,000 / yearKey responsibilities include developing the annual brand plan, overseeing the creation of compelling brand assets, designing sales enablement tools, executing demand generation campaigns, supporting field events, and gathering and sharing actionable commercial insights. This role will also support long-term planning by identifying emerging market trends, understanding the evolving needs of customers and the sales team, and translating those insights into impactful marketing strategies.
NewRN, Clinical Documentation Integrity Specialist myPlace HealthRN, Clinical Documentation Integrity SpecialistLos Angeles, California$71,700–$105,000 / yearOperating within the PACE model, the CDI Specialist conducts clinically supported chart reviews, identifies documentation opportunities, and collaborates with physicians, nurse practitioners, and care teams to support compliant CMS-HCC capture and sustainable documentation improvement. This clinically credentialed role partners with providers, interdisciplinary care teams, and risk adjustment stakeholders to ensure documentation reflects each participant’s clinical complexity, disease burden, severity of illness, and care needs.
NewPatient Authorization and Referral Representative - Gastroenterology Providence Health & ServicesPatient Authorization and Referral Representative - GastroenterologyCalifornia, CARequsition ID: 456736 Company: Providence Jobs Job Category: Patient Access Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Admin Support Department: 7520 GASTROENTEROLOGY CA DOYLE PARK 303 Address: CA Santa Rosa 500 Doyle Park Dr Work Location: St Joseph Heritage-Pediatrics-Doyle Park Workplace Type: On-site Pay Range: $26.25 - $40.14 The Referral Coordinator prepares clinical data for physician/IPP/CBO approval and obtains authorizations; acts as liaison between patient, medical assistant, physician, IPP, CMS Department and Central Business Office.
Utilization Management Assistant - Utilization Management Providence Health & ServicesUtilization Management Assistant - Utilization ManagementMission Hills, CA$24–$31.52 / hourTogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care.