Job Summary and Responsibilities. The Manager, Delegation Oversight Monitoring (DOM) reports directly to the Director of Delegation Oversight Performance Monitoring (DOPM). This manager will partner with the director to establish a specifically designed delegation audit program that effectively prevents and/or detects violation of applicable laws, regulations, and contractual requirements, which will protect the organization from liability. This ...
Job Summary and Responsibilities. The Manager, Delegation Oversight Monitoring (DOM) reports directly to the Director of Delegation Oversight Performance Monitoring (DOPM). This manager will partner with the director to establish a specifically designed delegation audit program that effectively prevents and/or detects violation of applicable laws, regulations, and contractual requirements, which will protect the organization from liability. This ...
Job Summary and Responsibilities. This position is work from home. within California. . In this role, you will execute all aspects of the referral process and promote the quality and cost effectiveness of medical care through strict adherence to all Utilization Management (UM) Policies and procedures promptly, efficiently and accurately. The UM Coordinator collaborates with clinical team members to evaluate the potential over and under-utilizatio...
Job Summary and Responsibilities. This position is remote, but will be expected to work PST business hours. In this Business Analyst I role, you will serve as the internal consultant for the Managed Care Operations team, providing analysis, reporting, and operational support across a variety of functions, including credentialing, contracting, claims, provider relations, quality/risk, care coordination, utilization management, and business develop...
Job Summary and Responsibilities. This position will be hybrid work from home and in-clinic, requiring up to 50% travel to provider offices primarily in the Bakersfield/Central CA region. . . Position Summary. The Medical Director of Physician Engagement is responsible for developing and driving implementation of physician and APP focused strategies that aim to drive new business, network expansion and the enhancement of population health, health...
Job Summary and Responsibilities. The Population Health Service Organization (PHSO) is the primary population health and value based entity within CommonSpirit Health. It manages and coordinates both a centralized MSO as well as various CIN's/ACO's (value hubs) across the nation. The Vice President of Finance is accountable for driving financial strategy and leading efforts to achieve financial performance and operating goals of the PHSO and its ...
Job Summary and Responsibilities. This role is the key clinical leader for Managed Care Services within the Population Health Services Organization, responsible for providing the clinical vision, strategy, and agenda. Reporting directly to the. System VP, Population Health Physician Executive, this role will drive clinical excellence, accountability, and alignment across the contracted physician networks, impacting key performance indicators rela...
Job Summary and Responsibilities. The Clinical Integration (CI) and Accountable Care Organization (ACO) programs are clinically integrated physician networks sponsored by Dignity Health (DH). In order to fill service gaps in a CI/ACO Network, a complementary network of ancillary providers is maintained in each region. The Provider Data Management Specialist is an employee of Dignity Health Management Service. Under the direction of the Manager, t...
Job Summary and Responsibilities. The Claims Recovery Manager is responsible for leading the recovery operations within the MSO Claims department. This role oversees all efforts to identify, validate, and recoup overpayments, as well as enhance controls to prevent future payment errors. The Recovery Manager works in close coordination with internal audit, provider dispute resolution, and finance to maximize cost recovery, reduce payment errors, a...
Job Summary and Responsibilities. This position is remote, but will be expected to work CST/PST business hours. Position Summary. This position will act as an expert clinical and education resource. staff and leadership development consultant. and Utilization Management content expert for staff, leaders, physicians and customers across the ePH Utilization Management. This position will assist with the design and implementation of onboarding for n...
Job Summary and Responsibilities. This position is remote, with a preference for candidates residing in the Eastern or Central time zones. In this administration role, you will be responsible for partnership and strategic direction with the designated regional value hub leadership. Aligning direction of operations, processes and infrastructure with Enterprise Population Health CommonSpirit's Population Health Service Organization (PHSO), includin...
Job Summary and Responsibilities. The Claims Examiner III is an advanced-level role responsible for the detailed and accurate processing, review, and adjudication of complex healthcare claims. This position requires expert knowledge of claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most challenging cases, mentor junior staff, and contribute to the development of policies and procedures. Job Requireme...
