Operations Specialist III – Medicaid / Medi-Cal (Epic + Utilization Review

Pyramid Consulting, Inc; Long Beach (CA); Remote; USD 41,328 - 61,992; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid sick leave

Job summary

A leading healthcare consulting agency is seeking an Operations Specialist III for a contract opportunity in Long Beach, CA. This role requires expertise in Medicaid and Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart reviews, ensure documentation accuracy, and support Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour with various employee benefits including health insurance and a 401(k) plan.

Qualifications

• 1–2+ years healthcare operations experience, with 3–5 years ideal.
• Strong Medicaid / Medi-Cal background required.
• Experience with Epic EHR, Kaiser HealthConnect preferred.

Responsibilities

• Conduct Medicaid / Medi-Cal Chart Review.
• Perform comprehensive health chart and administrative chart reviews.
• Ensure documentation completeness and regulatory compliance.

Skills

Healthcare operations experience

Medicaid / Medi-Cal background

Epic EHR experience

Utilization Review exposure

Ability to work independently

Education

High School Diploma

Associate or Bachelor’s degree

Tools

Epic

Tapestry

Job description

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 elevate quality or utilization concerns
• Support Medicaid program performance metrics and reporting
• 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
• 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.

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