FULL_TIME

FEED

UNKNOWN

This position owns the daily, weekly, and monthly encounter data reconciliation lifecycles, manages staff performing sweeps and error resolution, tracks federal response files (999, 227CA, MAO-002), resolves clearinghouse rejections, and partners with internal teams to ensure valid HCCs successfully pass through all technical checkpoints. Key Responsibilities: Encounter Data Pipeline Oversight & Integrity: End-to-End Submission Management: Manage daily technical and operational data streams for all risk adjustment submissions, ensuring seamless transaction flows from internal claims systems through 837P/837I EDI layouts into RAPS and EDPS (or state Medicaid systems).

YEAR

Inland Empire Health Plan

Manager, Risk Adjustment Encounter Data Reconciliation

[AW]-iCims

Directs the Biomedical Department during regulatory inspections like The Joint Commission (TJC), DNV-GL, Hospital Facilities Accreditation Program (HFAP), and Center for Medicare & Medicaid Services (CMS), College of American Pathologists (CAP) and any other applicable State regulatory agencies. Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more.

Prime Healthcare Services Inc

Area Manager

OTHER

As part of the Akido medical network, we are currently responsible for more than 250,000 patients in Southern California, with plans to expand into new markets across the U.S. We care deeply about the communities we serve and are committed to providing accessible, high quality healthcare that helps our patients and communities live their fullest lives. This partnership joins CMG’s medical services with Akido’s innovative technology to relieve the frustrations felt by everyone involved in care delivery, from medical providers and their staff, to the patients and their families.

Chaparral Medical Group

Clinic Site Manager

greenhouse_via_bold

Clinic Site Manager - RN

Required: Ability to work effectively under pressure due to changing priorities, interruptions, high/low census, payor demands and discharge planning demands; Excellent interpersonal communication, including conflict resolution, problem solving and negotiation skills; Clinical knowledge of multiple age groups, medical illness and treatment plans according to disease process, diagnosis and anticipated LOS; Strong organizational and time management skills, as evidenced by capacity to multi-task and prioritize; Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients and their families; Demonstrates the knowledge and skills necessary to communicate with third party payers to obtain authorization for the appropriate treatment setting for patients requiring medical, psych and chemical dependency treatment; Must be proficient in required competencies upon completion of orientation and maintain annual departmental competency requirements; Ability to work collaboratively regardless of social, economic and cultural backgrounds; Computer knowledge to include skills in using Microsoft Office (Excel, Word, Power Point, Access). Physical Activity Requirements: Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation.

Rady Children's Health

RN Care Manager - Gastroenterology

Partner with engineering, supply chain, manufacturing, the owners of today's engineering and business systems, IT, Platform Engineering, and Cybersecurity to embed the digital thread into how products are designed, sourced, and built. Define and drive the digital thread roadmap across the platform, integrations, in-house applications, and workflow automation - including build-vs-buy decisions for core engineering and business systems, made together with the teams that own them today.

True Anomaly

Senior Manager, Digital Engineering

ea_via_bold

Own local and practice-level AI visibility: ensure PDS-affiliated practices surface and are cited correctly when patients query AI systems for local/condition-specific care (e.g., "best dentist near me," "dentist that treats X"); partner with Field Marketing and the MOD/Yext data pipeline to ensure listing and entity data quality supports this. Overview: The SEO Marketing Manager is responsible for the development, implementation, and management of PDS Health's search visibility strategy — spanning traditional SEO, answer engine optimization (AEO), and generative engine optimization (GEO) — across multiple national and localized PDS websites.

PDS Health

Mgr, Digital Marketing Organic Search

The Manager supports Payer Access & Reimbursement activities as a member of a cross-functional team, oriented to Medical Affairs (MA) activities related to medical access, evidence generation, value proposition creation, and coverage in policy, all of which impact the reimbursement of Quest's portfolio of tests. Collaborate with cross-functional teams (e.g., other MA teams, Clinical Discipline Specialists/Clinical Franchises, Health Plans, Billing, Coding/Compliance/Legal) to develop Payer Access strategies to optimally support business needs.

Quest Diagnostics Inc

Manager, Coverage & Market Access

Ability to: Develop and implement compliance and auditing programs; apply legal and administrative compliance policies to hospital or health systems; analyze data, draw logical conclusions, conduct independent audits, reviews, and make evaluations to ensure compliance issues and concerns are appropriately evaluated, investigated and resolved; recommend effective courses of action; communicate effectively in oral and written form; establish and maintain effective working relationships; conduct independent systems analyses of complex business processes. Knowledge of: Information security; theory, principles and practices of general healthcare; governmental accounting, budgeting and auditing; HIPAA privacy and security rules and regulations; privacy laws, rules and regulations relating to information and security; federal, state and local codes, rules and regulations including healthcare fiscal operations; the methods of developing systems forms for various types of accounting records and reports; information systems and their application to accounting operations; the principles, methods and techniques of public administration, personnel and business office management; the principles and techniques of supervision.

County of Riverside, California

RUHS Compliance Program Manager

Performs a combination, but not necessarily all, of the following duties: Interview patients, take vital signs (such as pulse rate, temperature, blood pressure, weight and height) and record information; Properly utilize Electronic Health Records system, recording all required and/or relevant information in the system; Prepare treatment rooms for examination of patients; Drape patients with covering and positions instruments and equipment; Hand instruments and materials to medical provider as directed; Clean and sterilize instruments; Operate X rays, electrocardiograph (EKG), and other equipment to administer routine diagnostic test or calls medical facility or department to schedule patients for tests; Give injections or treatments, and performs routine laboratory tests; Key data into computer to maintain office and patient records as necessary (Misys, LINK); Keep exam and treatment rooms clean, well-stocked; Set up equipment in exam rooms; Perform hearing screening, plotting growth parameters; Advise patients concerning preparation for tests; Document administration of immunizations and medications in chart; Administer immunization injections/treatments (must be done only with licensed provider on premises); Call patients to provide normal and abnormal lab results; Keep logs: lead, medications, record refrigerator temperature and zero scales daily and abnormal TB results; Calibrate lab machines as needed and urine machines monthly; Provide translation for providers or arrange for translation services; Travel between clinic sites to cover staffing shortages; Provide back-up to front desk responsibilities including receptionist duties, clerical duties such as filling out forms, answering telephones or filing; Electronic Health Record (EHR) inputting prescriptions and patient's chart; Practice Management System (PMS) Registration, Scheduling and Billing; File medical charts when needed; Maintain patient flow to reduce waiting time; Perform lab proficiency testing, run in-house lab tests, prepare outside lab specimens, check lab orders and bills for accuracy; Participate in MA review of charts; Send out Medical Records when requested by other offices; Attend staff meetings; Inventory and order medical supplies and materials; Notify Clinic Manager when supplies need to be ordered or when vaccines or medications are out; Serve as advocate for Indigent Program organizing forms for providers, instructing patients, helping patients complete forms and serving as liaison with drug companies; Comply with all personal medical requirements including but not limited to: annual physical, current vaccinations (MMR, Tdap, Influenza, Hepatitis B), and TB testing (skin test or chest x- ray); Attend meetings, trainings, and other work-related events as needed; and. Two years' related experience; Medical terminology knowledge; Strong charting/documentation skills; Pediatric vaccination knowledge preferred; Experience in community organizing; Experience working in underserved communities such as undocumented workers, unaccompanied minors, LGBT populations, communities of color, youth/adolescents, and those experiencing homelessness, substance abuse, and/or mental illness; and.

ST. JOHNS WELL CHILD AND FAMILY CENTER, INC.

Medical Assistant Floater

This role is responsible for leading a team of supervisors, patient engagement specialists, and billing professionals, while managing external vendor partnerships to ensure efficient scheduling, consistent member outreach, and timely billing and submission of completed visits. Working closely with our Nurse Practitioner (NP) team and cross-functional partners, this individual will help maximize appointment completion rates and ensure providers have the scheduled visits needed to support program success.

Astrana Health, Inc.

Manager - Annual Wellness Visit Programs

PinpointHQ

Senses of vision, hearing and smell sufficient to regularly operate a motor vehicle, to visualize threats in the environment or risks to clients, and to operate safely in the field. Working knowledge of CalAIM payment reform, CPT and HCPCS coding for SMHS, CMS-1500 and 837P claims, and County Mental Health Plan billing.

South Coast Children's Society Inc

Revenue Cycle Manager

South Coast Community Services

Overview: Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

PHS Bio-Medical Services

Manager - Materials Management

The ideal candidate is a highly organized technical program manager with experience supporting software engineering teams, change management initiatives, AI-enabled development practices, and cross-functional execution. Partner with Engineering teams to define and track adoption metrics, productivity gains, cycle-time improvements, quality signals, rework, test coverage, and other ROI indicators.

HOUR

HM Electronics, Inc.

AI Program Manager, Temporary

You will combine depth in one area (such as statistical programming and reporting, data integration, data visualization, data science and machine learning, or data and software engineering) with enough breadth across clinical data, analytics and AI to deliver on your own, with the support of the team. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company’s sole and absolute discretion, consistent with applicable law.​.

AbbVie

Senior Manager, Trial Surveillance & Analytics (Hybrid)

SmartRecruiters_Organic_Non_Easy_Apply

You will combine depth in one area (such as statistical programming and reporting, data integration, data visualization, data science and machine learning, or data and software engineering) with enough breadth across clinical data, analytics and AI to deliver on your own, with the support of the team. Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law: The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position.

AbbVie Inc

Senior Manager Trial Surveillance & Analytics Hybrid

Rivian may use your Candidate Personal Data for the purposes of (i) tracking interactions with our recruiting system; (ii) carrying out, analyzing and improving our application and recruitment process, including assessing you and your application and conducting employment, background and reference checks; (iii) establishing an employment relationship or entering into an employment contract with you; (iv) complying with our legal, regulatory and corporate governance obligations; (v) recordkeeping; (vi) ensuring network and information security and preventing fraud; and (vii) as otherwise required or permitted by applicable law. Rivian may share your Candidate Personal Data with (i) internal personnel who have a need to know such information in order to perform their duties, including individuals on our People Team, Finance, Legal, and the team(s) with the position(s) for which you are applying; (ii) Rivian affiliates; and (iii) Rivian's service providers, including providers of background checks, staffing services, and cloud services.

Rivian

Sr. Manager, Marketing Analytics

IRecruitee

Skills/Experience REQUIRED: Acute Hospital; Long Term Acute Care/Rehab/Skilled Nursing; Admission Criteria; Care Coordination; Discharge Planning; Utilize InterQual Criteria; Utilize Milliman Guidelines; UR Admission Criteria; UR Appeals and Denials; UR Concurrent Review; UR Continued Stay Reviews; UR Medical Necessity; UR Retrospective Review; UR Utilize InterQual Criteria; UR Utilize Milliman Guidelines; CMS: Centers for Medicare and Medicaid Services; CPT (Current Procedural Terminology) coding and billing; Department of Health; DRG (Diagnosis Related Groups); HEDIS (The Healthcare Effectiveness Data and Information Set) Measures; HIPAA guidelines (Health Insurance Portability and Accountability Act); ICD 10 Coding; NCQA (National Committee for Quality Assurance); OSHA; The Joint Commission/ Core Measure/National Safety Goals. Case Manager and Utilization Review RN for Cancer Specialty Hospital.

IMCS Group Inc

Registered Nurse/Case Manager

jobdiva

Required: Ability to work effectively under pressure due to changing priorities, interruptions, high/low census, payor demands and discharge planning demands; Excellent interpersonal communication, including conflict resolution, problem solving and negotiation skills; Clinical knowledge of multiple age groups, medical illness and treatment plans according to disease process, diagnosis and anticipated LOS; Strong organizational and time management skills, as evidenced by capacity to multi-task and prioritize; Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients and their families; Demonstrates the knowledge and skills necessary to communicate with third party payers to obtain authorization for the appropriate treatment setting for patients requiring medical, psych and chemical dependency treatment; Must be proficient in required competencies upon completion of orientation and maintain annual departmental competency requirements; Ability to work collaboratively regardless of social, economic and cultural backgrounds; Computer knowledge to include skills in using Microsoft Office (Excel, Word, Power Point, Access). Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation Physical Activity Lifting .

Playwright Jobs in the United States

Manager, Risk Adjustment Encounter Data Reconciliation Inland Empire Health Plan

Area Manager Prime Healthcare Services Inc

Clinic Site Manager Chaparral Medical Group

Clinic Site Manager - RN Chaparral Medical Group

RN Care Manager - Gastroenterology Rady Children's Health

Senior Manager, Digital Engineering True Anomaly

Mgr, Digital Marketing Organic Search PDS Health

Manager, Coverage & Market Access Quest Diagnostics Inc

RUHS Compliance Program Manager County of Riverside, California

Medical Assistant Floater ST. JOHNS WELL CHILD AND FAMILY CENTER, INC.

Manager - Annual Wellness Visit Programs Astrana Health, Inc.

Revenue Cycle Manager South Coast Children's Society Inc

Revenue Cycle Manager South Coast Community Services

Manager - Materials Management PHS Bio-Medical Services

AI Program Manager, Temporary HM Electronics, Inc.

Senior Manager, Trial Surveillance & Analytics (Hybrid) AbbVie

Senior Manager Trial Surveillance & Analytics Hybrid AbbVie Inc

Sr. Manager, Marketing Analytics Rivian

Registered Nurse/Case Manager IMCS Group Inc

RN Care Manager - Gastroenterology Children's Hospital of Orange County

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