- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. In this key ... leadership role, you'll work closely with the UHMAP Medical Director and play a vital part...policy that's grounded in the latest scientific research and Medicare guidelines. Your work will directly support our Health… more
- Dignity Health (Bakersfield, CA)
- …to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other related ... offices primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing… more
- Molina Healthcare (San Bernardino, CA)
- …corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews… more
- Cognizant (Sacramento, CA)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a... Medicare , Medicaid, and third-party guidelines. . Effectively document and… more
- Cedars-Sinai (CA)
- …Express) no later than date of discharge. + Communicates regularly with CSMPN Medical Director , Employee Health Services, Risk Management, and TPA + Attends ... 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded...Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and… more
- J&J Family of Companies (Los Angeles, CA)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ; practice management, as well as Medicare and Medicaid ... administrators, CFOs, billing and collections staff, clinical staff including pharmacy director ; Health Plans' and MCOs' Medical Directors, Case Managers,… more