- Humana (Sacramento, CA)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CenterWell (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… 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...overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for… more
- Centene Corporation (Sacramento, CA)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... and Medi-Cal experience, preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Molina Healthcare (Sacramento, CA)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- Merck (Sacramento, CA)
- **Job Description** Associate Director , Field Access Management The Associate Director , Field Access Management serves as the leader to a team of subject-matter ... Market Access, Public Affairs, State and Government Affairs, Trade and Specialty Pharmacy Accounts while abiding by all corporate and industry policy and procedures.… more
- Sacramento County (Sacramento, CA)
- …and provide information on drugs and their actions + Advise and consult with medical and nursing staff regarding the properties of drug substances + Counsel patients ... a Registered Pharmacist issued by the State of California Board of Pharmacy . Note: If the minimum qualifications include an educational or certificate/license… more