- Elevance Health (Walnut Creek, CA)
- **Clinical Operations Medical Director ** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… 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 relies on medical background and reviews health claims....time to the Indiana Pathways program to assist the Utilization Management , Care Management , and… 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 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 ... 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
- 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
- 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
- Dignity Health (Rancho Cordova, CA)
- …This position will involve rotating Saturday coverage.** **Position Summary:** The Manager of Utilization Management (UM) is responsible for managing the day to ... day operation of Utilization Management Department and Prior Authorization (PA)...Additionally, the Manager will work in conjunction with the Director of UM on a variety of critical tasks… 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
- Kyndryl (Sacramento, CA)
- …and our communities. **The Role** We are seeking an experienced and dynamic Associate Director to join our Software Asset Management (SAM) team at Kyndryl. This ... licensing agreements. Responsibilities include: + Overseeing end-to-end software asset management across the organization. + Providing regular reporting and analysis… 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
- Elevance Health (Walnut Creek, CA)
- …Develops and enhances relevant clinical guidelines. + Provides clinical leadership for Utilization Management , Case Management , Disease Management , ... is looking to hire a **National Solution Medical Director for Post Acute Care Solutions** . This high-performing...Business Strategy, Product Strategy. + Experience with Managed Care, Utilization Management , Prior Auth, and Benefits … more
- Elevance Health (Walnut Creek, CA)
- …Develops and enhances relevant clinical guidelines. + Provides clinical leadership for Utilization Management , Case Management , Disease Management , ... Administrative Medicine, Business Strategy, Product Strategy. + Experience with Managed Care, Utilization Management , Prior Auth, and Benefits Management … more
- Sunrise Senior Living (Danville, CA)
- …me, that's a big breath of fresh air."_** **_- Sunrise Leader_** The Executive Director is responsible for overall leadership, management , and success of their ... These responsibilities include but are not limited to financial management , hiring, supervising, training, team member relations and recognition, communication,… 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
- Elevance Health (Walnut Creek, CA)
- …preferred. + Extensive spine surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For candidates ... **Clinical Operations Associate Medical Director ** **Neurosurgery** **Carelon Insights/Carelon Medical Benefits Management ** _A proud member of the Elevance… 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
- Elevance Health (Walnut Creek, CA)
- …clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management responsibilities including clinical ... within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director ** is responsible for the administration of behavioral health medical services,… more
- BrightSpring Health Services (Sacramento, CA)
- …or revision to quality improvement goals and objectives* Reinforce the consistent utilization of the company's Risk management systems to maximize the ... Our Company BrightSpring Health Services Overview The Director , Operations Support partners with operations to ensure quality and integrity in services and stability… 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