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.

  • 2 Months Ago

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Medical Equipment Supply Specialist/Repairs/Delivery
  • Assurance Medical Supply, INC
  • Rancho Cucamonga, CA FULL_TIME
  • Assurance Medical is a growing Medical Supply Company / DME loctaed in Rancho Cucamonga.We are seeking a reliable Delivery Driver to join our team. The ideal candidate will be responsible for transpor...
  • 6 Days Ago

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Medical Front Office - Patient Service Specialist
  • Select Medical Holdings Corporation
  • Upland, CA PART_TIME
  • Job ID 306622 Location US-CA-Upland Experience (Years) 0 Category Administrative - Administrative Services Street Address 299 West Foothill Boulevard Company Select Physical Therapy Position Type Part...
  • 2 Months Ago

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Automotive/Diesel Technician
  • ROME'S AUTO SPECIALIST INC
  • Riverside, CA FULL_TIME
  • ROME’S AUTO SPECIALIST INC Is seeking a highly skilled and experienced Diesel/Gas Master Technician to join our team. The ideal candidate will have 10 years of hands-on experience diagnosing and repai...
  • Just Posted

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Fleet Job Coordinator / Porter
  • 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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NP
  • Azar Foot & Ankle Specialist
  • Montclair, CA FULL_TIME
  • Must have an active Medical State License and continue valid maintenance of the licenseWilling to work as a team and independently, provide valuable ideas and feedbackWilling to work at two different ...
  • 1 Day Ago

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0 Medical Policy Specialist jobs found in Riverside, CA area

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Physical Therapist
  • Concentra
  • Moreno Valley, CA
  • Overview Bonus Potential! Monthly and Quarterly Bonus Incentives! Are you ready to take your career to new heights? At C...
  • 12/12/2024 12:00:00 AM

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Dealership Accounting Coordinator 1
  • Lithia Motors, Inc.
  • Riverside, CA
  • Dealership: L0605 Southwest Finance Center Riverside Subaru The Dealership Accounting Coordinator ("DAC") I is an indivi...
  • 12/12/2024 12:00:00 AM

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Travel Physical Therapist - $2,600 per week
  • TheraEx Therapy
  • Riverside, CA
  • TheraEx Therapy is seeking a travel Physical Therapist for a travel job in Riverside, California. Job Description & Requ...
  • 12/12/2024 12:00:00 AM

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NEMT Wheelchair Driver - Riverside, CA
  • Horizon Transportation Llc
  • Riverside, CA
  • Job Description Job Description NEMT (Non-Emergency Medical Transportation) Driver – Riverside, CA Horizon Transportatio...
  • 12/12/2024 12:00:00 AM

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Pharmacist - Specialty OP Pharmacy- PD Variable
  • University of California, Irvine
  • Orange, CA
  • Overview: Position Summary: The University of California, Irvine, a career destination unlike any other, is built upon a...
  • 12/11/2024 12:00:00 AM

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Lead EHS Specialist
  • Air Distribution Technologies, Inc.
  • Riverside, CA
  • Build your best future with the Air Distribution Technologies, Inc. Team. As a global leader in providing innovative air...
  • 12/11/2024 12:00:00 AM

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Travel Nurse RN - Labor and Delivery - $2,512 per week
  • Hiring Now!
  • Riverside, CA
  • Triage Staffing is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Riverside, California. Job D...
  • 12/11/2024 12:00:00 AM

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Medical Assistant PRN
  • Concentra
  • Irvine, CA
  • Overview: Are you ready to take your career to new heights? At Concentra, you will be a vital member of our patient care...
  • 12/9/2024 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
$96,830 to $118,198
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