Medical Policy Specialist jobs in Riverside, CA

Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Outreach Specialist - Policy
  • Reach Out West End Inc.
  • Upland, CA FULL_TIME
  • Reach Out has been serving the Inland Region of Southern California for 52 years, underpinning a deep well of experience in community cohesiveness and organizing, and empowering communities to make transformational change on social justice issues. When needed, our aim is to be an effective, positive disruptor of the status quo. Our core work of strengthening communities takes many forms, from direct services to youth and families, to deep root cause work in building the health and quality of life of our region.

    We are seeking an Outreach Specialist who will be responsible for developing networks among individuals, groups, organizations, and agencies through policy community-based approaches. This position is required to provide on-site services and/or outreach interventions in diverse, lower socioeconomic areas at various times of the day and evening.

    Essential Functions

    · Community outreach, conduct presentations, community involvement and participation on key committees, organizations, collaboratives in the Inland Empire.

    · Establish partnerships with local agencies and neighboring cities, communities, businesses and agencies.

    · Work within contract/funding source guidelines/requirements.

    · Partner with program staff/volunteers and interns as needed.

    · Collect data and enter outreach outcome statistics.

    · Cross-department collaboration, training and support.

    · Create and maintain a creative, positive, sustainable, and supportive work environment.

    · Ensures the adequacy of information delivered to the community and the provision of high quality, culturally sensitive referrals.

    · Displays sensitivity to the service populations cultural and socioeconomics characteristics.

    · Performs work in a safe manner at all times and abide by safety practices.

    · Performs other duties as assigned.

    This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments.

    Experience

    · A minimum of five years of community engagement experience.

    Licenses and Certifications

    · Valid California Driver’s License is required.

    · Must maintain insurance on vehicle.

    • Vaccination is required by the first day of work and Reach Out will consider accommodations for disability- and religious-based reasons.

    Additional Qualifications

    To perform this job successfully, an individual should have the following general knowledge

    · Experience conducting outreach to culturally diverse communities.

    · Experience in work within substance use prevention, nutrition, community safety, etc.

    · Ability to work a flexible schedule including some evenings, if needed.

    · Sound organizational and time management skills to manage high and varied activity level.

    · Ability to be an excellent representative of the agency to the community.

    · Excellent written and verbal communication skills.

    · Excellent organizational skills and an ability to manage and prioritize duties are necessary to be successful in this position.

    · Ability to effectively and successfully interact with individuals from diverse socio-economic/ethnic groups.

    · Proactive, flexible, creative, and enthusiastic attitude.

    · Ability to make sound judgments and follow and give complex directions.

    · Ability to work with diverse groups of stakeholders, including parents, children, and community officials.

    · Fluent English/Spanish preferred.

    Physical and Mental Demands:

    · Able to work in a high paced high demand environment

    · Able to travel to and attend meetings throughout the counties in the Inland Empire

    · Annually attend out of State or County conferences per contract requirements

    · Able to work flexible hours including evenings and weekends

    · Able to publicly speak, give presentations, facilitate workshops, etc.

    · Able to work with diverse populations

    Reach Out is an Equal Opportunity / Affirmative Action Employer committed to providing equal employment opportunities to all qualified applicants without regard to race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability or handicap, pregnancy, gender identity and/or expression, sexual orientation, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

  • 9 Days Ago

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Medical Assistant Specialist
  • Chaparral Medical Group
  • Rancho Cucamonga, CA FULL_TIME
  • Summary: Responsible for covering clinical offices based on operational need. Assists in the examination of patients under the direction of a Physician and in accordance with M.A. scope of practice. T...
  • 13 Days Ago

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Automotive Service Advisor/Writer
  • ROME'S AUTO SPECIALIST INC
  • Riverside, CA FULL_TIME
  • ABOUT ROME’S AUTO SPECIALIST INC Since 2011, Rome’s Auto Specialist Inc has become a recognized industry leader in Automotive & Fleet Maintenance Services. Our goal is to simply provide honest and tru...
  • 1 Day Ago

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Pool Cleaner/Technician
  • Pool & Spa Specialist
  • Rancho Cucamonga, CA FULL_TIME
  • MUST HAVE EXPERIENCE! Pool & Spa Specialist -Highly reliable and self motivated individual wanted -Must have experience in cleaning pools & spas -In depth knowledge & clear understanding of water chem...
  • 11 Days Ago

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Comfort Specialist (Sales)
  • Integrity Air Your Heating & Cooling Specialist
  • Murrieta, CA FULL_TIME
  • INTEGRITY AIR? Are you looking for a place to call home? A place where your skills and passion will be recognized and rewarded? A place to grow and learn with others who have the same mindset? We call...
  • 27 Days Ago

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Billing Specialist
  • PRIME MEDICAL SUPPLY, INC
  • Corona, CA FULL_TIME
  • Must be bilingual with preferably history of medical equipment billing (DME). Best candidate will have HMO billing in medical equipment field. Company in business since 1994 serving Southern Californi...
  • 16 Days Ago

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0 Medical Policy Specialist jobs found in Riverside, CA area

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Driver, Shuttle CDL Class B
  • InnovAge
  • San Bernardino, CA
  • Responsibilities Caring Shuttle Driver to transport our frail senior patients InnovAge Drivers provide transportation fo...
  • 4/26/2024 12:00:00 AM

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Family Practice Physician Needed in Southern Orange County
  • Provider Healthcare
  • Orange County, CA
  • Job Description Job Description Job Type – Full Time Schedule - Days Pay – From $240,000 - $260,000 annually plus incent...
  • 4/26/2024 12:00:00 AM

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Pediatrician
  • Community Health Systems, Inc.
  • Bloomington, CA
  • Job Description Job Description ESSENTIAL DUTIES AND RESPONSIBILITIES: 1. Upholds and supports the mission, philosophy, ...
  • 4/25/2024 12:00:00 AM

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Claims Examiner -Remote
  • Generis Tek Inc
  • Irvine, CA
  • Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
  • 4/25/2024 12:00:00 AM

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Claims Examiner –Remote
  • Generis Tek Inc
  • Irvine, CA
  • Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
  • 4/23/2024 12:00:00 AM

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Medical Assistant Back Office
  • OC UROLOGY
  • Santa Ana, CA
  • Job Description Job Description Responsibilities Our Medical Assistants greet our patients, obtain their medical histori...
  • 4/23/2024 12:00:00 AM

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Mobile Phlebotomist - PT - Orange, CA
  • Getlabs
  • Orange, CA
  • Getlabs is the nationwide leader for at-home diagnostics. Healthcare organizations use our all-in-one technology platfor...
  • 4/23/2024 12:00:00 AM

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Mobile Phlebotomist - PT - Anaheim, CA
  • Getlabs
  • Anaheim, CA
  • Getlabs is the nationwide leader for at-home diagnostics. Healthcare organizations use our all-in-one technology platfor...
  • 4/23/2024 12:00:00 AM

Riverside is a city in Riverside County, California, United States, located in the Inland Empire metropolitan area. Riverside is the county seat of the eponymous county and named for its location beside the Santa Ana River. It is the most populous city in the Inland Empire and in Riverside County, and is located about 55 miles (89 km) east of downtown Los Angeles. It is also part of the Greater Los Angeles area. Riverside is the 59th most populous city in the United States and 12th most populous city in California. As of the 2010 Census, Riverside had a population of 303,871. Riverside was fou...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$95,080 to $116,061
Riverside, California area prices
were up 3.0% from a year ago

Medical Policy Specialist in Norfolk, VA
Guideline 9 – specialist medical procedures provides that applications for the separate representation of children with an intellectual impairment in relation to applications for special medical procedures are not subject to the means test or merits test.
February 20, 2020