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Online Resumes with "DMHC"
Compliance Auditor
Compliance Auditor with 10 plus years of HMO claims experience. I have strong ethical background. I use the tools I have learned to help groups/hospitals to become compliant with all federal and state regulations
Ideal Companies: HealthNet, CalOptima or DMHC.
Medical or Health Services Manager - 16 Years of Experience - Near 95628
Areas Of Expertise * Call Center Metrics * HR Procedures, Recruiting * Business Process & Analytics * Revenue Cycle Management * Business Process Design * Workforce Management * Curriculum Design * API & EDI Integration * ePremis, CE2000, ClaimForce, CRM, Great Plains * ACA/DMHC Regulations * PBM Operations
Tags for this Online Resume: Call Center, Insurance, Outsourcing, Protocol, Billing, Documentation, Scheduling, Triage, Audit, Coding
Registered Nurse - 20 Years of Experience - Near 95670
Career Summary: Over 20 years of experience in Acute Care and Health Service programs including Utilization Review, Provider Dispute Resolution, Quality Management, Inpatient and Ambulatory Case Management, and Grievance and Appeals in a managed care environment for both Health Plan and IPA/MSO settings using evidence based nationally recognized criteria such as ACOG, NCCN, MCG, InterQual and Health Plan Medical guidelines ...
Tags for this Online Resume: Compliance, Management, Quality Management, Assessments, Medical, Medicare, registered nurse, healthcare, Managed Care, Utilization Management
Director - 20 Years of Experience - Near 92708
SUMMARY Seeking a position where I can utilize my accomplished leadership skills in nursing, management and organization to provide projected, qualitative client and business outcomes. To utilize my nursing and leadership background and extensive knowledge of Managed Care, including Commercial, Medicare, and Medicaid experience, in an environment where excellence, professionalism, and vision are valued. Talented interviewer...
Tags for this Online Resume: Management, Cms, Integrate, Medicare, Assessments, Leadership, Planning, Quality, Quality Assurance
Quality Manager - 25 Years of Experience
Accomplishments * Published "A New Quality Approach to Reducing Vascular Access Infections" in the Nephrology Nurses Journal (2011) as a national Continuing Education Unit (CEU) for Nursing. * Published Four Pinnacle Award performance improvement projects through Health Care Association of New York (HANYS) (2007) Profiles in Quality and Patient Safety. * End Stage Renal Disease (ESRD) Network Quality Champion Award received...
Tags for this Online Resume: Managed Care, Consulting, Manufacturing, Process Improvement, Cms, Management, Root Cause Analysis, Medicare, Quality, Quality Assurance
Chief Financial Officer - 5 Years of Experience - Near 90740
Qualifications Summary: * Versatile senior professional with a background in Big 4 public accounting, financial reporting including SEC, DOI and DMHC filings, internal, operational and compliance auditing, Sarbanes-Oxley implementation and compliance, financial planning and analysis, financial and operating systems evaluations, Fortune 100 industry experience and operations under Chapter 11 of the US bankruptcy code * Exten...
Tags for this Online Resume: Management, Internal Controls, Audit, Documentation, Financial, Financial Services, Process Improvement, Regulatory Reporting, Services, Test
