at the Alameda Alliance. This position leads in communications with State agencies and internal departments for privacy... knowledge of business products and related Alliance policies and procedures and alerts the compliance staff of non-compliance...
paperwork, helping them work through testing, answering questions regarding the Alameda Alliance for Health companion guides..., and approving providers for claims submissions after successful test cycles have been completed. ESSENTIAL FUNCTIONS OF THE...
for Alameda Alliance for Health. This role will lead the identification, assessment, and mitigation of risks across the... trends Knowledge of health plan management, compliance, finance, accounting, assurance and control principles Proficiency...
experience of members for Alameda Alliance for Healths (the Alliance) Medicare Advantage Dual Eligible Special Needs Plan (D-SNP... regulatory requirements for all Medicare Advantage D-SNP member program initiatives across the Alliance. Principle...
Department of the Alameda Alliance for Health (health plan), and assists the Chief Medical Officer (CMO) in developing... and implementing clinical policy designed to meet the DHCS triple aim: improving the patient experience of care; improving the health...
providers to close gaps in care and work collaboratively with Alameda Alliance for Health to improve quality of care and meet... Alliance for Health (health plan) and assists the Chief Medical Officer in developing and implementing clinical policy designed...
Adjustment program for Alameda Alliance for Healths (the Alliance) Medicare Advantage Dual Eligible Special Needs Plan (D-SNP... and implementation of the Risk Adjustment program for the Alliance and the Medicare Advantage D-SNP product that is consistent with the...
to ensure they meet the requirements of Alameda Alliance for Healths (Alliance) regulatory agencies and/or guidelines... provider file audits to ensure that credentialing procedures meet regulatory requirements and Alliance standards...
, and evaluation of HEDIS and Stars performance improvement strategies for Alameda Alliance for Healths (the Alliance) Medicare... initiatives for the Alliance and Medicare Advantage D-SNP product that is consistent with the vision and mission of the Alliance...
at Alameda Alliance, overseeing IT services to ensure employees receive top-notch support. This involves monitoring and measuring... seeking solutions for systemic issues and process enhancements. Be responsible for the IT services at Alameda Alliance...
of business Participate in the Health Equity Improvement Committee, D-SNP quality sub-committee, Pharmacy and Therapeutics... in the Board of Governors meetings, as requested Encourage and educate providers to effectively manage the delivery of health...
and implement projects, programs, and initiatives that support the achievement of health plan goals as it relates to the Alliances... owner to supplemental benefit vendors and acts as a liaison from vendor point of contacts (POCs) to health plan leadership...
of the Alliance, transforming data into insights to drive business values. This position requires an in-depth understanding... OR TRAINING EQUIVALENT TO: Bachelors degree in a business, health related, finance, technical or other related field of study...
of the Alliance, transforming data into insights to drive business values. This position requires an in-depth understanding... OR TRAINING EQUIVALENT TO: Bachelors degree in a business, health related, finance, technical or other related field of study...
matter expert (SME) in training for the Alliance and Medicare Advantage D-SNP product that is consistent with the vision... and mission of the managed care health plan. Trains and reports on market research within local, community, State, and Federal...
for coordinating, monitoring and maintaining the credentialing and recredentialing processes of health care providers and practitioners... to ensure they meet the requirements of the Alliance credentialing policies and regulatory agencies (i.e., Title 22, NCQA, DHCS...
Department of Managed Health Care (DMHC), the Department of Health Care Services (DHCS), and Centers for Medicare & Medicaid... Alliance at state agency and professional association meetings, trainings, conferences and webinars related to new regulatory...
, the Senior Business Analyst works with complex business processes, understands the Alliance's overall data landscape...): Working knowledge of health care industry. Ability to communicate effectively, both verbally and in writing. Ability to work...
The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit...
RELATED EXPERIENCE: Minimum of three (3) years of experience within a health plan environment required.Minimum of one (1...): Background in health education, health information, and/or general wellness a plus.Strong understanding of web platforms, digital...