Operations Specialist III – Medicaid / Medi-Cal (Epic + Utilization Review
Immediate need for a talented Operations Specialist III – Medicaid / Medi-Cal (Epic + Utilization Review. This is a 06+months contract opportunity with long-term potential and is located in Long Beach, CA(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 26-02810
Pay Range: $30 - $45/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)
Key Responsibilities:
• Medicaid / Medi-Cal Chart Review
• Perform comprehensive health chart and administrative chart reviews
• Ensure documentation completeness and regulatory compliance
• Identify and escalate quality or utilization concerns
• Support Medicaid program performance metrics and reporting
• Utilization Review & Authorizations
• Conduct Utilization Review activities
• Support authorization workflows and payor processes (Anthem, Blue Shield, etc.)
• Review medical necessity documentation
• Collaborate with clinical and administrative teams to resolve discrepancies
• Epic & Workflow Execution
• Navigate and abstract data within Epic (HealthConnect preferred)
• Manage assigned review queues and documentation workflows
• Track operational performance metrics
• Suggest workflow improvements where applicable
• Operational & Process Support
• Assist in centralizing and refining hospital/system-wide workflows
• Support productivity standards and cost-reduction initiatives
• Contribute to operational efficiency and sustainability projects
• Schedule: 8:00 AM – 4:30 PM
• 5 days/week including every other weekend (Saturday & Sunday
Key Requirements and Technology Experience:
• 1–2+ years healthcare operations experience (3–5 years ideal)
• Strong Medicaid / Medi-Cal background
• Experience with Epic EHR (Kaiser HealthConnect highly preferred)
• Utilization Review exposure (authorization workflows, Tapestry preferred)
• Experience conducting chart reviews (clinical or administrative)
• Ability to work independently post-training
• Stable healthcare employment history
• Education: High School Diploma required; Associate or Bachelor’s degree preferred.
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
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Job ID: 26-02810
Pay Range: $30 - $45/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)
Key Responsibilities:
• Medicaid / Medi-Cal Chart Review
• Perform comprehensive health chart and administrative chart reviews
• Ensure documentation completeness and regulatory compliance
• Identify and escalate quality or utilization concerns
• Support Medicaid program performance metrics and reporting
• Utilization Review & Authorizations
• Conduct Utilization Review activities
• Support authorization workflows and payor processes (Anthem, Blue Shield, etc.)
• Review medical necessity documentation
• Collaborate with clinical and administrative teams to resolve discrepancies
• Epic & Workflow Execution
• Navigate and abstract data within Epic (HealthConnect preferred)
• Manage assigned review queues and documentation workflows
• Track operational performance metrics
• Suggest workflow improvements where applicable
• Operational & Process Support
• Assist in centralizing and refining hospital/system-wide workflows
• Support productivity standards and cost-reduction initiatives
• Contribute to operational efficiency and sustainability projects
• Schedule: 8:00 AM – 4:30 PM
• 5 days/week including every other weekend (Saturday & Sunday
Key Requirements and Technology Experience:
• 1–2+ years healthcare operations experience (3–5 years ideal)
• Strong Medicaid / Medi-Cal background
• Experience with Epic EHR (Kaiser HealthConnect highly preferred)
• Utilization Review exposure (authorization workflows, Tapestry preferred)
• Experience conducting chart reviews (clinical or administrative)
• Ability to work independently post-training
• Stable healthcare employment history
• Education: High School Diploma required; Associate or Bachelor’s degree preferred.
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
Apply tot his job
Apply To this Job