- CVS Health (Sacramento, CA)
- …of covered benefits in the Commercial and Medicare environment with a focus Medicare policy., This Medical Director provides subject matter expertise in ... day. **Position Summary** Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a… 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 be passionate… 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 + Must be… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CenterWell (Sacramento, CA)
- …and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy ... a part of our caring community and help us put health first** The National Medical Director for Home-Based Care Programs is a key clinical leadership position… 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 as an… 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 as an… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... timely and accurate manner. . 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 as an… more
- Centene Corporation (Sacramento, CA)
- …+ Managed Care and Medi-Cal experience, preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Evolent (Sacramento, CA)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Sacramento, CA)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... Experience conducting Medi-cal reviews Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. *… more
- Genesis Healthcare (Elk Grove, CA)
- …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time team members. + **Support ... professional development program. Responsibilities The Assistant or In-Training (IT) Director of Rehab is responsible for assisting the ...period of one year. 3. A thorough knowledge of Medicare and third party billing is also required. Posted… more
- Grifols Shared Services North America, Inc (Sacramento, CA)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- Humana (Sacramento, CA)
- …, Informatics** will be responsible for supporting Patient Safety analytics on the Medicare population. The Associate Director is expected to perform and present ... of our caring community and help us put health first** The Associate Director , Informatics coordinates with other analytics, IT and business areas across the… more
- Elevance Health (Walnut Creek, CA)
- **Provider Network Management Director ** **Location:** This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while ... accommodation is granted as required by law. The **Provider Network Management Director ** is responsible for developing and managing the provider network through… more