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Remote Medicare Risk Adjustment Jobs in California

Wider Circle

Care Advocate - Care Delivery

Stockton, CA · On-site +1

$25.51/hr

Execute person-centered care plans for patients with serious, high-risk illnesses. Assist in ... Remote Independence: Successfully work in a remote team environment with high independence and ...

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Remote Medicare Risk Adjustment information

What is the difference between Remote Medicare Risk Adjustment vs Remote Medical Coding Specialist?

AspectRemote Medicare Risk AdjustmentRemote Medical Coding Specialist
CertificationsCPR, CPC, or RAC certifications often preferredCPC, CCS, or CCS-P certifications
Work EnvironmentHealthcare insurance companies, Medicare plansHospitals, clinics, insurance companies
Industry UsagePrimarily in Medicare risk adjustment programsMedical billing and coding across various healthcare settings

Remote Medicare Risk Adjustment and Remote Medical Coding Specialist roles share certifications and healthcare industry usage but differ in focus. Medicare Risk Adjustment involves analyzing patient data to optimize Medicare plan reimbursements, while Medical Coding Specialists translate medical records into billing codes. Both roles require healthcare knowledge but serve distinct functions within the healthcare revenue cycle.

What are the most commonly searched types of Medicare Risk Adjustment jobs in California?

The most popular types of Medicare Risk Adjustment jobs in California are:

What are popular job titles related to Remote Medicare Risk Adjustment jobs in California?

For Remote Medicare Risk Adjustment jobs in California, the most frequently searched job titles are:

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The top searched job categories for Remote Medicare Risk Adjustment jobs in California are:

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Cities in California with the most Remote Medicare Risk Adjustment job openings:

Remote Medicare Risk Adjustment jobs near you

UM Coordinator (SNF / Post-Acute Authorizations) California Residents

A-Line Staffing Solutions

Alameda, CA • Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

It's a strong base, but for Haley you'll usually get better applicant flow and better self-filtering if we make it tighter, more keyword-dense, and more "this is exactly SNF transitions/authorizations" (while still clean and skimmable). Below is a better Haley-optimized version (still within your rules, 300–400 words, no company name, no temp language). Long Term Care Coordinator (SNF / Discharge Planning) – Remote (California) Location: Remote (California residents only) Schedule: Monday–Friday, 8:00 AM–5:00 PM (Pacific Time) Pay: Not provided Summary Hiring a Long Term Care Coordinator with hands-on SNF (Skilled Nursing Facility) coordination experience in a managed care setting.

This Long Term Care Coordinator supports post-acute transitions and authorization workflows for Medi-Cal/Medicare members, with a heavy focus on hospital-to-SNF placement, continued stay tracking, bed holds/LOA, discharge planning support, and documentation. If you've worked directly with SNF admissions teams and hospital discharge planners and you understand UM/authorization processes, this is a high-match role.

Responsibilities

Coordinate SNF admissions, continued stay reviews, and transitions of care (hospital → SNF, SNF → home, LTACH/IRF as applicable) Process, track, and follow up on SNF/LTC authorizations and related supportive services (DME, home health, therapies, transportation) Partner with SNF staff, hospital discharge planners, providers, and members/families to remove barriers and ensure timely placement/discharge Review clinical documentation to support level of care and medical necessity requirements Maintain accurate case notes and status updates in UM/case management systems; meet productivity and turnaround-time expectations Monitor pending items, request missing records, and escalate delays or high-risk cases appropriately Support compliance with managed care policies, procedures, and regulatory documentation standards (HIPAA) Qualifications Recent experience coordinating with Skilled Nursing Facilities (SNF) on admissions, transitions, and discharge planning workflows Experience in managed care operations: UM/UR support, prior authorization, referrals, and documentation-driven processing Working knowledge of Medi-Cal and Medicare member populations and provider network workflows Strong organizational skills with high-volume follow-up, documentation accuracy, and time-sensitive processing Clear, professional communication with providers, facilities, and members; HIPAA/privacy compliant Preferred: experience with InterQual or MCG (Milliman) and post-acute authorization platforms Preferred: experience with bed holds / leave of absence (LOA) and post-acute benefit coordination

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About A-Line Staffing Solutions

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A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

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