Medi-Cal Redetermination Application Coordinator

Job Summary: We are seeking an Eligibility Continuity Specialist to provide full Redetermination of Eligibility (RE) application assistance to IEHP Members to help maintain their Medi-Cal eligibility.Key Responsibilities:Conduct outbound calls to IEHP Members to help them understand the Medi-Cal Redetermination of Eligibility (RE) process and complete the RE...

Job Summary:">This role involves providing assistance to IEHP members with their Medi-Cal redetermination applications, ensuring they maintain their eligibility and receive the necessary support.About Inland Empire Health Plan:">We are a leading health plan dedicated to delivering high-quality care to our members. Our team is passionate about making a...

Job Summary: The Grievance and Appeals Nurse - Hybrid will be responsible for reviewing case coding accuracy, resolving medical grievances, and coordinating care with practitioners, providers, and entities/agencies involved in patient care. This role requires strong clinical review skills, knowledge of Medi-Cal and Medicare benefits/regulations, and...

About Alta HospitalsAt Alta Hospitals, we are committed to delivering high-quality patient care and innovative medical solutions. Our organization is dedicated to advancing healthcare through research, education, and community engagement.Job Description**Role Summary:**We are seeking an experienced Billing Specialist to join our team at Alta Hospitals. This...

**About the Role:**The Clinical Services Coordinator (CSC), Advanced plays a vital part in ensuring timely and accurate processing of Treatment Authorization Requests. As a member of our team, you will work closely with clinical staff to support day-to-day operations for Promise (Medi-Cal) or Commercial/Medicare lines of business.**Key...

Required Skills and Qualifications\To be considered for this position, you must possess the following qualifications:\\A minimum of five (5) years of experience performing medical reviews in support of a healthcare Special Investigations Unit.\Bachelor's degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, or related field from an...

OverviewThe Utilization Management Prior Authorization team plays a critical role in ensuring timely and accurate prior authorization of designated healthcare services. As a Care Coordination Clinical Specialist, Senior, you will be responsible for performing first-level determination approvals for members using evidence-based guidelines, policies, and...

Overview of the RoleThe Blue Shield Clinical Service Coordinator Advanced will support clinical staff in day-to-day operations for Promise (Medi-Cal) and Commercial/Medicare lines of business. In this role, you will be responsible for timely and accurate processing of Treatment Authorization Requests.Your ResponsibilitiesWork in a production-based...

Key ResponsibilitiesPerform prospective utilization reviews and first-level determination approvals for members using evidence-based guidelines, policies, and nationally recognized clinical criteria.Ensure discharge planning at levels of care appropriate for members' needs and acuity, and determine post-acute needs, including levels of care, durable medical...

Job OverviewWe are seeking a skilled Clinical Review Specialist to join our Medi-Cal Appeals and Grievances team. This role involves performing accurate and timely clinical reviews of member appeals and grievances, ensuring compliance with National Coverage Determination (NCD) guidelines and other relevant regulations.The successful candidate will have...

About the RoleThe Utilization Management Nurse, Senior will be responsible for ensuring the accurate and timely prior authorization of designated healthcare services. This professional will report to the Manager, Utilization and Medical Review, and be responsible for performing first-level determination approvals for members using BSC evidence-based...

About Our CompanyJM Temporary Services & Affiliates, Inc., dba JM Staffing, JM Medi-Stat is proud to be an equal opportunity workplace. We strive to create a diverse and inclusive work environment that values creativity, innovation, and teamwork.Job DescriptionThe Fiscal Assistant will be responsible for reviewing and auditing accounting documents to ensure...

Job OverviewBBSI Southern California is seeking a highly skilled Project Coordinator to provide high-level support to a Project Manager. This position requires excellent organizational and communication skills, with the ability to work independently and as part of a team.Estimated Salary: $40,000 - $50,000 per yearThis role offers a unique opportunity to...

This role offers a unique blend of administrative and technical duties, requiring strong problem-solving skills and attention to detail. As a Trucking Permits Processing Specialist, you will be responsible for coordinating trucking permits and ensuring compliance with federal regulations.You will work closely with our clients to understand their needs and...

Job DescriptionKnown for their innovative Korean food products, Cesna is seeking a highly skilled and dedicated individual to fill the position of Production Coordinator. As a key member of our production team, you will be responsible for overseeing various aspects of manufacturing operations.Key ResponsibilitiesCoordinate and manage production activities to...

OverviewBBSI Southern California is a leading provider of staffing and recruitment services. We are seeking an experienced Project Coordinator to join our team in Southern California.Estimated Salary: $40-$55 per hour.Job DescriptionWe are looking for a highly skilled Project Coordinator to provide high-level support to our project managers, coordinating...

About the RoleThe United Firm | La Liga Defensora, APC. is seeking an experienced Accounts Receivable Coordinator to oversee our monthly receivables efforts. This position will partner with our Finance Team and Legal Department to ensure customer complaints and service downfalls are addressed and mitigated. The ideal candidate will have a strong attention to...

Southwest Mobile Storage is a family-owned shipping container business founded in 1995, serving over 24,000 commercial, construction, and residential customers. We are an equal opportunity employer and prohibit discrimination and harassment of any kind.As a Regional Heavy Haulage Specialist or Southern California Storage Logistics Coordinator, you will work...

Job OverviewBBSI Southern California is seeking a highly skilled and experienced Project Coordinator to join our team. This individual will play a critical role in supporting our project management team, ensuring the smooth execution of projects from planning to completion.Key ResponsibilitiesCoordinate project activities, including scheduling meetings,...

Gunn Psychological Services, part of the Optum family of businesses, is seeking a Licensed Behavioral Clinician or Therapist to join our team in Rancho Cucamonga, CA.Optum Behavioral Care:A clinician-led care organization revolutionizing the way clinicians work and live.Changing the landscape of healthcare by making it better for everyone.About the...