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Grievance & Appeals Nurse (RN Preferred) - Work from Ho...

Health Net, Inc. - Los Angeles, CA

Position Purpose: Review clinical data to determine claim payment based on company policies and National Committee for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases ..

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Marketing Specialist - Military veterans preferred

Health Net, Inc. - Clayton, MO

Position Purpose: Develop and produce marketing materials and coordinate website changes.Interface with various departments and ensure consistency in branding and image Act as liaison and collaborate with subsidiaries and company departments on ..

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Senior Compliance Analyst

Health Net of California - Rancho Cordova, CA

Senior Compliance Analyst The candidate will assist in maintaining Centene Corporation’s Compliance Program. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance auditing and monitoring strategies. ..

Provider Database Coordinator - Military veterans preferred

Health Net, Inc. - Rancho Cordova, CA

... and Provider Data Services staff to ensure Health Net provider data is current and accurate. Duties ... for the accuracy and timeliness of Health Net provider data.\nEnters provider data according ...

Pharmacy Technician Medicare D Operations CA - Rancho Corova ...

Health Net, Inc. - Rancho Cordova, CA

... requests from Health Net plansSubmits and maintains formulary change requests to Health Net\u2019s ... requestsMaintains expert knowledge on all Health Net Medicare Pharmacy benefits and formularies ...

Senior PC3 Field Operations Representative - Military vetera...

Health Net, Inc. - , OH

... claims, benefits, issues and authorization inquiries within delegated authority. \nInterprets Health Net\u2019s policies and procedures. Provides interpretation and clarification of benefits ...

Infrastructure Support Specialist - Military veterans prefer...

Health Net, Inc. - Rancho Cordova, CA

... the incumbent will gain knowledge of Health Net\u2019s Enterprise Level wiring standards and ... Remedy tickets and installations of Health Net\u2019s Information Systems network infrastructure.Installs, ...

Manager, Provider Network Operations (Woodland Hills) - Mili...

Health Net, Inc. - Los Angeles, CA

... Credentialing Advisory Committee, regional Delegation Oversight Committee, Peer Review Committee, Health Net Quality Improvement Committee, and other national/regional steering committees\nMaintains ...

Lead Behavioral Health Professional *Crisis Line, Bilingual...

Health Net, Inc. - Tempe, AZ

Position Purpose: Monitor real time call flow and provide guidance and direction to behavioral health call center personnel to ensure call metrics and standards are met or exceeded according to ...

Health Care Analyst - Military veterans preferred

Health Net, Inc. - Rancho Cordova, CA

Position Purpose: The Health Care Analyst provides analytic support to one or multiple departments and develops a variety of complex ad hoc, production and/or trend reports to support business ...

Healthcheck Coordinator I - Military veterans preferred

Health Net, Inc. - Smyrna, GA

Position Purpose: Conduct outreach (via telephone and mail) to encourage enrollees to access preventive care; assist with making appointments and arrangements as necessary. Communicate the importance ...

Customer Service Representative II - Military veterans prefe...

Health Net, Inc. - Lenexa, KS

Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner Reference current materials to answer escalated and complex inquiries from ...

Supervisor, Compliance - Military veterans preferred

Health Net, Inc. - Lenexa, KS

Position Purpose: Plan, coordinate, and perform compliance oversight functions Supervise workgroups on compliance initiatives, implementation of new vendors and changes to existing products\nMonitor ...

Supervisor, Coding Analytics - Military veterans preferred

Health Net, Inc. - Chesterfield, MO

Position Purpose: Ensure Coding Analytics team consistently meets production standards and passes quality auditsOversee relationships with health plans, claims, and other departments resulting in a ...

Manager, Claims & Contract Support Services - Military v...

Health Net, Inc. - Chesterfield, MO

Position Purpose: Oversee the operation of the Contract Implementation Analyst and Claims Liaison teams Oversee the claims operation function, including contracting and configuration\nMonitor staff ...

Member Advocate I - Military veterans preferred

Health Net, Inc. - Sunrise, FL

Position Purpose: Act as an advocate for the Member and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote Member ...

VA Medical Document Representative I - Military veterans pre...

Health Net, Inc. - Gold River, CA

Position Purpose: The Medical Documentation Representative I reviews and processes medical documentation for veterans sent by providers. The Representative contacts providers for appointment ...

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