Positions in this function analyze and monitor claims against potential fraud, waste and abuse related to network pharmacies Investigate, review, and analyze claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of potential fraudulent, erroneous, or abusive billing activity on Real Time Application System and vario

Acts as a patient advocate in the coordination and delivery of quality patient care Maintains patients' dignity by protecting patients' rights to privacy, confidentiality, and safety Works as a team with all ancillary services to expedite and coordinate patient care Directs patient to proper exam/treatment area and prepares patient for examinations and other procedures. A

Consistently performs high quality digital 2D and 3D tomosynthesis screening mammograms Effectively uses mammography equipment Effectively uses computer systems (i.e., I site, Epic, Epic Radiant, MRS, and Hologic Manager) and understands how they affect the end result Performs exams in a timely manner and is able to stay on schedule Fosters an excellent relationship with

Delivers high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparing for diagnostic tests or procedures at various sites and departments within an assigned geographic region Collects and documents patient information, including vital signs, chief complaints, reviews of medications, allergies, heal

Optum is looking for a GI Nurse Practitioner/Physician Assistant to join our Urgent Care team in Redlands .The clinicians we seek are those who practice medicine with a focus on patient care, not volume. We want our clinicians to take the time needed to truly address the patient's needs. If you're looking to join a community that is making a difference in healthcare,Optum

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customer Closely monitors patient safety at all times, i.e., does not leave the patient on an exam table unattended and participates in Optum fall prevention program Supervises clini

Consistently exhibit behavior and communication skills demonstrating Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customer Perform all functions of a UM nurse reviewer Compose denial letter in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standard

Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced based criteria within the documentation system Performs expedite

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each internal and external customer Perform all functions of the UM nurse reviewer Composes denial letter in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA sta

Deliver high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collect and document patient information, including vital signs, chief complaint, review of medications, allergies, health risk screen information, the status of extended care benefits, and oth

Oversee processing of physician adds, terms and demographic changes Review and verify provider panel status and current health plan IDs Manage and maintain current roster of primary care and specialty care physicians Support patient retention workflows during provider network changes Distribute materials, performance/patient data, and communications to physician network S

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Serves as a primary point of contact between patient and health care team to anticipate and appropriately address patient questions and concerns. Confirms patient u

Deliver high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collect and document patient information, including vital signs, chief complaint, review of medications, allergies, health risk screen information, the status of extended care benefits, and oth

Life Changing Work Want to make a real difference in the lives you touch? LOOK NO FURTHER. Optum provides management services to multiple long respected physician groups in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing doctors like you. As part of our continu

Coordinate, supervise and accountable for the daily / weekly / monthly activities of a team of 15 to 20 Medical Collections Representatives Set priorities for the team to ensure task completion and performance goals for the team are achieved Coordinate work activities of team with other supervisors, managers, and departments Participate in the recruitment, training, and s