- Novo Nordisk Inc. (Sacramento, CA)
- …productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights ... Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level business acumen and… more
- Sutter Health (Sacramento, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- The Cigna Group (Sacramento, CA)
- …Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health care ... services in conjunction with the physician treatment plan. Handles more complex, high acuity cases,...facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness… more
- Veterans Affairs, Veterans Health Administration (Fairfield, CA)
- …sections including, but not limited to, specialists, nursing staff, social services, utilization management , and other members of the interdisciplinary care team ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Centene Corporation (Sacramento, CA)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- Evolent (Sacramento, CA)
- …reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business Managers to ... review process. Responsible for the quality of utilization review determinations, including appeals. + Provides...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Cardinal Health (Sacramento, CA)
- …Specialty Networks works with over 11,500 providers across 3500+ independent specialty physician practices and now over 850 members. Furthermore, this business unit ... and solutions to our industry partners. The _Sr. Specialist, Account Management (UroGPO Member Development)_ is responsible for supporting all regional programming,… more
- Evolent (Sacramento, CA)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Sacramento, CA)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as,... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Sacramento, CA)
- …As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Sacramento, CA)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Highmark Health (Sacramento, CA)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed ... at all times. In addition to utilization review , the incumbent participates as the physician ...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Dignity Health (Rancho Cordova, CA)
- …the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for coordination of ... sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF Utilization Management guidelines… more
- Humana (Sacramento, CA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Sacramento, CA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Elevance Health (Walnut Creek, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences :** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
- Humana (Sacramento, CA)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge… more
- Travelers Insurance Company (Sacramento, CA)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work...and other medical resources as appropriate. Train and evaluate physician and non- physician medical review … more
- Sutter Health (Sacramento, CA)
- …case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager, Medical Social Worker and bedside RN to assure… more
- Insight Global (Sacramento, CA)
- …is being delivered Participates in the Outcomes Management and annual program review Performs utilization review of continuous care and inpatient levels ... eligibility and appropriateness criteria are met Collaborates with both the team physician and the attending physician regarding palliative care measures for… more
