Remote: Highly qualified candidates, residing in California, Arizona, Nevada, Oregon, Texas, Colorado, Minnesota, Florida, and Georgia, will be considered for remote work. You must be a resident of one of these states to be considered for remote opportunities.
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing & monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Job Duties and Responsibilities:
Education:
High school diploma/GED required. Bachelor’s Degree in Healthcare or related field preferred.
Experience:
Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience required. Five (5) years of compliance experience, preferably in a healthcare environment.
Working Title:
Managed Care Compliance Specialist – Managed Care (REMOTE)
Department:
MNS – Managed Care
Business Entity:
Medical Network
Job Category:
,Strategic Plan/Business Dev,Strategic Plan/Business Dev
Job Specialty:
Managed Care
Position Type:
Full-time
Shift Length:
8 hour shift
Shift Type:
Day
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.
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