- Molina Healthcare (Long Beach, CA)
- … director , and quality improvement staff. Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. Reviews quality referred ... relevant experience, including: 2 years previous experience as a Medical Director in a clinical practice. Current...without restrictions to practice and free of sanctions from Medicaid or Medicare . PREFERRED EDUCATION: Master's in… more
- MBK Senior Living (Petaluma, CA)
- …government found not eligible to provide care and services in a facility that receives Medicare or Medicaid funding. If employed at one of our senior living ... Executive Director At MBK Senior Living, we're committed to putting people...communities that receives Medicare or Medicaid funding, team members must not be… more
- CenCal Health (Santa Barbara, CA)
- …Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization, quality, ... on business needs. Duties & Responsibilities Provides clinical leadership for medical management functions; assists subordinate managers in resolving medical … more
- MBK Senior Living (Manteca, CA)
- …government found not eligible to provide care and services in a facility that receives Medicare or Medicaid funding. If employed at one of our senior living ... and personal coaching through our Mentor, Buddy, and Executive Director in Training Programs -Education loan assistance & scholarships...communities that receives Medicare or Medicaid funding, team members must… more
- Quipt Home Medical Corp (Burbank, CA)
- …*Strong communication skills with capacity to make independent decisions * Medicare / Medicaid and insurance billing, bookkeeping or medical office experience ... Quipt Home Medical is a rapidly growing leader in the...Position: Customer Service Representative Position Reports To Branch Manager/CSR Director Position Summary As a Customer Service Representative, you… more
- LA Care Health Plan (Los Angeles, CA)
- …the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- myPlace Health (Los Angeles, CA)
- …expert knowledge , including a strong understanding of community resources, Medicaid / Medicare , and public benefit programs to help participants thrive. ... supportive leader , with direct reporting to our Executive Director , ensuring guidance and collaboration every step of the...success! Preparing you for retirement: 401k with Employer match Medical Plans to fit your needs: Your choice of… more
- University of Southern California (Arcadia, CA)
- …in maintaining compliance with the Joint Commission (TJC) and Center for Medicare / Medicaid standards and conditions of participation. Having oversight for ... support to staff, patients and families. Works in collaboration with the medical and hospital staff to provide multidisciplinary care of patients. Utilizing… more
- Elevance Health (Costa Mesa, CA)
- ** Medical Director - Medicare and Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... required by law. **Candidates must live in California.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market… more
- Humana (Sacramento, CA)
- …of the managed care industry including Medicare Advantage and Managed Medicaid . + Utilization management experience in a medical management review ... caring community and help us put health first** The Medical Director relies on medical ...organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review 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… more
- 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 +… more
- Humana (Sacramento, CA)
- …SNF, DME, dual Medicare / Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Humana (Sacramento, CA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director relies on medical ...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- Humana (Sacramento, CA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director actively uses their medical...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- Humana (Sacramento, CA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director relies on medical ...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- Humana (Sacramento, CA)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Evolent (Sacramento, CA)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more
- Evolent (Sacramento, CA)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more
