Senior Actuary Health Plan Analytics ReveleerSenior Actuary Health Plan AnalyticsCARemote$150,000–$185,000 / yearThis role builds member-level actuarial models that quantify risk adjustment performance, HCC (Hierarchical Condition Category) capture, medical economics, utilization, and population health trends, and translates those models into customer-facing dashboards that inform pricing, forecasting, and program strategy. Reveleer is hiring a senior actuary to lead health plan and risk adjustment analytics for each line of business for Reveleer customers across Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), Affordable Care Act (ACA), Medicaid, and provider value-based contracts.
NewSupervisor Grievance and Appeals CalOptimaSupervisor Grievance and AppealsOrange, CA$84,092–$134,548 / yearBachelor's degree PLUS 1 year of experience of health care management experience, preferably in a managed care environment in related areas of responsibility of utilization management, quality management, customer service or grievances and appeals required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. We are hoping you will join us as a Supervisor Grievance and Appeals and help shape the future of healthcare where you'll be an integral part of our GA - Provider Disputes team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders.
Medical Director, Clinical Policy L.A. Care Health PlanMedical Director, Clinical PolicyLos Angeles, CAThis position ensures clinical policies and utilization management frameworks are evidence-based, operationally sound, compliant with regulatory and accreditation requirements, and aligned with organizational goals related to quality, safety, affordability, and member experience. The Medical Director oversees policy architecture, authorization strategy, and utilization oversight across all lines of business, ensuring clinical intent is accurately translated into authorization requirements, coding structures, and system configuration through partnership with internal teams.
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. 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.
Medical Assistant/ Insurance verifier , authorization specialist Apex Practice Management GroupMedical Assistant/ Insurance verifier , authorization specialistNorthridge, CAFull timeThe ideal candidate will be responsible for obtaining insurance authorizations and check eligibility for medical procedures and services, ensuring timely approvals to facilitate patient care. - Communicate with healthcare providers, insurance companies, and patients to gather necessary information.
Pharmacovigilance Specialist Grifols SAPharmacovigilance SpecialistLos Angeles, CA$95,000–$105,000 / yearExample: If a job level requires a Bachelor's degree plus 4 years of experience, an equivalency could include 8 years of experience, an Associate's degree with 6 years of experience, or a Master's degree with 2 years of experience. Serves in an advisory capacity including activities such as product monographs review; draft responses to pharmacovigilance requests from regulatory agencies; participates in the drafting and implementation of pharmacovigilance contracts and agreements.
Revenue Assurance Specialist IV - CDM and Epic experience needed Kaiser PermanenteRevenue Assurance Specialist IV - CDM and Epic experience neededPasadena, CAPerforms routine review and maintenance of system codes by: performing a regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; conducting pre- and post-implementation assessments of automated and manual charge capture for quality and accuracy; analyzing moderately complex billing issues related to charges/codes and proposing and implementing action plans to resolve charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications. Executes monitoring activities and process improvements by: independently performing tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; recording findings in accordance with relevant policies/procedures to ensure complete and consistent data integrity, partnering with other departments to resolve moderately complex deficiencies and/or compliance issues identified through monitoring activities; communicating results of monitoring activities to senior team members and/or department leaders; and implementing corrective action plans resulting from monitoring activities.
Clinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRID University of California, IrvineClinical Documentation Specialist 4 HX - Clinical Doc Integrity - FT Days HYBRIDIrvine, 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.
Finance Systems Analyst Hogan LovellsFinance Systems AnalystLos Angeles, CA$100,000–$125,000 / yearThis will involve attending project meetings and working with other departments in Finance and Technology as required in relation to the projects concerned, keeping the appropriate manager regularly informed of progress and developments. The team currently consists of the Finance Systems Manager with analysts based in London and Hong Kong, a Senior Finance Systems Manager with analysts based in the US, and a Finance Systems Manager - Product Owner based in London.
NewHealthcare Contract Definition Analyst - Medical Group Experian Information Solutions IncHealthcare Contract Definition Analyst - Medical GroupCARemoteExperian''s people first, inclusive and purpose driven culture is multi award-winning; World''s Best Workplaces 2025 (Fortune Global Top 25), Great Place To Work in 26 countries to name a few. You''ll have opportunity to: Analyze as well as, define, medical group contracts for Medicare, Medicaid, Workers'' Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payers.
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.
Provider Success & Training Specialist Cohere Health Technologies LLCProvider Success & Training SpecialistCARemote$65,000–$82,000 / yearBacked by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
Sr. Manager, Engineering Cohere Health Technologies LLCSr. Manager, EngineeringCARemote$185,000–$225,000 / yearOpportunity Overview: We are seeking a Senior Engineering Manager to lead our Review Engineering team - roughly 20+ engineers across three squads in the US and India - building the workflows and capabilities that let clinical operations staff deliver care at scale, efficiently and with high quality. Leading through dedicated technical leads on each squad, you''ll own the reliability and technical direction of Review''s systems while partnering closely with Product, Design, Security, Clinical Operations, and peer engineering teams on shared platforms.
Certified Risk Coder Astrana Health IncCertified Risk CoderMonterey Park, CAThe Certified Risk Coder plays a critical role in supporting Astrana Health"s value-based care and risk adjustment initiatives by ensuring the accurate capture and validation of diagnoses through comprehensive medical record review and coding analysis. The ideal candidate brings strong coding expertise, a passion for provider education, and a commitment to enhancing organizational performance through accurate risk capture, regulatory compliance, and continuous process improvement.
Commercial Managed Care Collections and Denials Manager - HB Patient Financial Services - FT Days University of California, IrvineCommercial Managed Care Collections and Denials Manager - HB Patient Financial Services - FT DaysAnaheim, 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. Responsibilities: Position Summary: The Commercial/Managed Care Collections/Denials Manager reports to the Assistant Director-Patient Financial Services and is responsible for managing hospital accounts receivables (A/R) and the collections, denial, and workflow activities for Commercial/Managed Care payers – Commercial, Managed Care, Workers Compensation, TriWest/VA and all other third-party payers.
Manager, Payment Integrity Program Development & Innovation HGS Healthcare LLCManager, Payment Integrity Program Development & InnovationCAJob Description: Manager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments. Manager, Payment Integrity Program Development & Innovation is responsible for leading a team of healthcare payment integrity experts focused on developing, implementing, and optimizing complex audit programs that identify and recover healthcare overpayments.
Pharmacy Biller/Office Manager Oncare PharmacyPharmacy Biller/Office ManagerDowney, CaliforniaCompletion of classes in medical terminology, anatomy and physiology, ICD-9 and Current Procedural Terminology (CPT) coding conventions, and disease process from an accredited program. At least two (2) year billing experience in private or health care organization (preferred but required); Experience with physician or ambulatory setting coding preferred.
Medical Records Director Sun Mar Health CareMedical Records DirectorLos Angeles, CaliforniaDevelop and maintain a good working rapport with inter-department personnel, as well as other departments within the facility to assure that medical records can be properly maintained and problem areas can be identified and corrected. We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our guests with a care experience that will change their lives!
Claims Auditor MedPOINT ManagementClaims AuditorSherman Oaks, CARemoteFull timeMedPOINT Management is a leading Independent Practice Association (IPA) management company serving the greater Los Angeles area, dedicated to delivering high-quality, coordinated healthcare to patients across Southern California. Our team enjoys a collaborative work culture, opportunities for professional growth, and the satisfaction of making a meaningful impact in the healthcare industry.
Medical Director Utilization Management Cohere Health Technologies LLCMedical Director Utilization ManagementCARemote$240,000–$250,000 / yearBy unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. With an enterprise approach that streamlines payer-provider decision-making across the care continuum-including policy, prior authorization, payment accuracy, and more-the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.