- Elevance Health (Walnut Creek, CA)
- ** Medical Director - Medicare and Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... and skill development. 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)
- …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)
- …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 our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical … more
- Humana (Sacramento, CA)
- …clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid , and ... caring community and help us put health first** The Medical Director actively uses their medical...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … 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)
- …caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid builds strategies for ... across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ...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
- 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… more
- Evolent (Sacramento, CA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... 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… more
- Evolent (Sacramento, CA)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... exclusions, sanctions, or disciplinary actions by **state or federal healthcare programs ( Medicare , Medicaid , OIG, or GSA).** Join us at **Evolent Health**… more
- Humana (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... our caring community and help us put health first** The Associate Director , Software Engineering leads software development application team based on business… more
- Humana (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will...starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +… more
- Humana (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Insurance IT organization is seeking an experienced and strategic Associate Director , Technology Solutions to lead technology efforts within the Enrollment domain.… more
- Humana (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... of our caring community and help us put health first** The Director , Risk Adjustment Strategy Advancement will provide business intelligence and strategic planning… more
- Evolent (Sacramento, CA)
- …data + Actuarial experience in value-based care across payers (Commercial, Medicaid , Medicare Advantage) **is not essential, however strongly preferred.** ... as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial Services utilizes and develops analytical tools to solve… more
- CenterWell (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Leaders to identify and influence enhancements to technology to improve the medical coder experience. + Oversees coding operations by identifying business partner… more
- Humana (Sacramento, CA)
- …experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more