- Humana (Sacramento, CA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Sacramento, CA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Humana (Sacramento, CA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager/ Director , the Supervisor of Utilization Management is responsible ... (Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… more
- CenterWell (Sacramento, CA)
- …a part of our caring community and help us put health first** **National** ** Director of Transitional Care and High-Risk Patient Management ** The Director ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Humana (Sacramento, CA)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Sanofi Group (Sacramento, CA)
- Position Summary This position reports to the Senior Director , Value & Access and Provider Accounts, Transplant & T1D and is responsible for serving as the medical ... to open patient access to care with Thymo. The National Business Director will demonstrate strong relationships with Chief Medical Officers, Medical Benefit… more
- Wolters Kluwer (Sacramento, CA)
- …data rich and can be effectively leveraged to maximize the efficiency, accuracy, and utilization of clinical data. As the Director , you will play a critical ... **BASIC FUNCTION** We are seeking a highly skilled and experienced Consulting Director of Solution Optimization within Health Language to lead the efforts for… more
- BrightSpring Health Services (Sacramento, CA)
- …of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure adequate ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- CenterWell (Sacramento, CA)
- …under the PCO's Chief Medical Officer. This role reports to the National Director , High Risk Patient Management . Responsibilities will include: + Lead ... community and help us put health first** The National Director , Clinical Pharmacy is a strategic pharmacy leader responsible...care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and serve as a national… more
- Humana (Sacramento, CA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims...reviews health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity… more
- Rocket Software (Sacramento, CA)
- …programs, and strategies to ensure effective, repeatable, and scalable project management , resource utilization practices, and reporting. + Foster global ... BELIEVE in what they're doing!** **Job Description Summary:** The Senior Director , Customer Solutions Engineering (CSE) is responsible for managing CSE Delivery… more
- CVS Health (Sacramento, CA)
- …consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management . In this role you ... Summary Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Cardiology) that can be remote based, work from home. This role can be… more
- CVS Health (Sacramento, CA)
- …consistent responses to members and providers. In addition you will oversee utilization review/quality assurance, directing case management In this role you'll ... **This is a remote based (work from home) role.** In the Medical Director role you will provide oversight for medical policy implementation. You'll participate in… more
- Sutter Health (Sacramento, CA)
- …care units for cardiac and neurological patients. The Oncology Nursing Director provides administrative and nursing leadership in an assigned inpatient setting ... patient care. Establishes overall operating and capital budget with input from management team, ensuring financial targets are achieved and variances are addressed… more
- Wolters Kluwer (Sacramento, CA)
- …units - Clinical Surveillance & Compliance ("CSC") and Health Language ("HL"). As Director Strategy CSCD Partnerships and Business Development you will play a key ... this will include establishment of KPIs related to expected performance including utilization , penetration of target markets and others, as appropriate to the… more
- Acxiom (Sacramento, CA)
- As a Senior Director , Data, you will be responsible for the growth, development, and implementation of Data Strategy services across Acxiom's business in North ... as an internal marketing, business/customer insights on the client side** **Project management experience using data to solve complex business questions and drive… more
- Dignity Health (Woodland, CA)
- …Empowers staff to create structures and processes that assures cost effective and safe utilization of drug supplies and pharmacy staff time. + Leads and creates the ... limited to new services/programs revenue enhancement expense reduction managed care utilization systems and inpatient and ambulatory strategies for pharmacy care +… more
- Sutter Health (Sacramento, CA)
- …include annual budget projections, project planning, analysis of product/service utilization , setting value goals with Sutter executives throughout the contracting ... process, price management and supplier performance. Is the subject matter experts of the health care manufacturing market. Develops and executes customer-focused… more
- Evolent Health (Sacramento, CA)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more