Expedite and oversee administrative process of clients' insured claims as assigned within region, including but not limited to general liability, builders' risk, professional liability, pollution, and auto liability claims. Essential Duties & Key Responsibilities As directed by Claims Manager, report claims in timely manner to applicable insurance carriers, and gather per

Your Role The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi Cal members under 21 years old and collaborates within Promise Clinical Team. The Case Management, Senior will report to the CHP Manager. In this role you will be Perform clinical review, assessment, evaluation of medical services for the organization us

REQUIRED EXPERIENCE Take on a significant role within a world class health organization. Elevate the operational and financial effectiveness of a complex health system. Take your professional expertise to the next level. You will leverage your extensive theoretical revenue cycle knowledge as you take on a vast range of critical revenue issues. This will involve applying d

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Registered Nurse Case Manager will report to the FEP Department M

Responsible for auditing and training claims staff on all Managed Care claims received from outside providers to ensure the Claims Examiners processed and adjudicated them accurately and consistently in accordance with outside Provider Contracts, State, Federal, CMS, DMHC and Health Plan contracts, internal departmental policies and procedures. Must maintain a productivit

Your Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with their care including a multidisciplinary team and the member's treating physicians . The Registered Nurse Case Manageme

Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Behavioral Health Registered Nurse Case Manager will report to th

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination o

Your Role The Case Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating MDs.. The Case Management Nurse, Senior will report to the Manager, Care Management. In this role you will determine, develop and imp

Load, process, and summarize various data types and files using MATLAB or similar program. Further organize, clean, sort, and analyze data using SPSS, R, SAS, or related data analysis programs and interpret meaningful findings in tables, graphs, and written form. Conduct casualty assessment using currently available high rate blast data and published computational models.

Accountable for a full range of provider relations including engagement with and development of prospective providers Design and implement strategies to increase the membership of providers in the network Create and execute a marketing plan to build and nurture provider network Identify needs in provider network, incorporating potential gaps related to composition, servic

Serves as administrative support for the Provider Relations team Resolves provider issues by interfacing with cross functional Optum teams Processes electronic communications via email, fax and text Coordinates mass mailing and outreach projects to providers and patients Helps the Operations team plan, prepare, and execute provider events and meetings Coordinates with int

Must have High school diploma, GED or equivalent required, Two year degree preferred. Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization. Minimum of 2 years previous direct experience that included verifying and maintaining provider information and provider contract configuration in a managed care transaction system .

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect

Working under the direction of the Manager, Claims, this position has direct responsible for the supervision of staff and for overseeing the day to day operations of the Claims Processing and UM Denial Letter Units. Additional responsibilities include reporting functions to ensure compliance with AB1455, attention to CMS guidelines and department policy and procedures. Pr