- AIG (San Francisco, CA)
- Claims Complex Director - Healthcare Professional Liability (HPL) Join us as a Claims Complex Director to take on key responsibilities within ... an impact + This position will ensure high quality claims handling within the Healthcare Professional Liability...+ 7+ years of medical malpractice / professional liability complex claims and/or complex litigation… more
- Humana (Sacramento, CA)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- CommonSpirit Health (Glendale, CA)
- …the Glendale, CA area and will travel within the Region. The Region Director Risk Management and Loss Prevention is responsible for orchestrating the successful ... market/local risk management professionals. Within an established framework, the Director develops, implements and assesses the effectiveness of Region-wide programs… more
- Prime Healthcare (Ontario, CA)
- …including Claims and Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals. + Integrates and coordinates services using ... and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical-utilization-management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Humana (Sacramento, CA)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
- Conviva (Sacramento, CA)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... 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)
- …relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and… more
- EPAM Systems (San Francisco, CA)
- …- go-to-market, sales, engagement delivery and practice development. As a **Managing Director - Insurance Advisory** , you will lead the demand generation, pursuit, ... and technology solution expertise. You'll drive the shaping and delivery of complex solutions, working with cross-functional teams in both business and technology.… more
- The Cigna Group (San Diego, CA)
- …lieu of a Bachelor degree. MBA or MHA preferred.** + **5+ years Healthcare Contracting and Negotiating experience involving complex delivery systems and ... **_HYBRID_** **_position aligned to the San Diego, CA market._** The ** Director ,** **Provider Contracting** serves as an integral member of the Provider… more
- Humana (Sacramento, CA)
- …The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Evolent (Sacramento, CA)
- …+ Bachelor's degree in a quantitative major (Economics, Statistics, Finance) or with a healthcare focus + 3-5 years of claims -based healthcare analytics ... health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek… more
- Gilead Sciences, Inc. (Foster City, CA)
- …aspirations. Join Gilead and help create possible, together. In this role, the Director will be responsible to deliver timely and actionable insights to inform and ... senior leaders across multiple functions and business units + Communicate complex dynamics/challenges clearly and concisely to senior leaders + Provide… more
- Gilead Sciences, Inc. (Foster City, CA)
- …Join Gilead and help create possible, together. **Job Description** The Director , Integrated Insights HIV Pipeline in Gilead's Global Decision Sciences & ... Gilead + Conducting secondary research: analyze secondary data sources (eg Rx, claims , EMR, epidemiology data) to produce descriptive and diagnostic summaries, and… more
- Gilead Sciences, Inc. (Foster City, CA)
- …or treat disease. As a research-based biopharmaceutical company, we are revolutionizing healthcare by bringing medicines to patients in the areas of unmet need ... Design IC Plan options to reflect brand strategy and unique/ complex market dynamics. Guide stakeholders to choose the best...deep knowledge of IC grade data (Xponent, DDD, SP, Claims ), systems and processes to liaise with Data Strategy… more
- Sutter Health (Sacramento, CA)
- …capitation terms including division of responsibility. + Thorough knowledge of healthcare delivery systems, integrated delivery systems and medical group practices, ... plan, including expert knowledge of key dimensions of health plan data: Claims , Enrollment, and Revenue. + Superior business acumen, exceptional analytical and… more
- Molina Healthcare (CA)
- …adequacy, issue escalations and JOCs. Entail heavy negotiations. Maintains critical Complex provider information on claims and provider databases. Synchronizes ... adequacy, financial performance and operational performance, in alignment with Molina Healthcare 's overall mission, core values, and strategic plan and in compliance… more
- Sharp HealthCare (San Diego, CA)
- …business practices. **What You Will Do** This position reports directly to the Director /Manager of Labor Relations, serving under the Vice President of Labor and ... and maintaining a positive labor-management relationship while protecting Sharp Healthcare 's interests. The Labor Relations Partner role is responsible for… more
- Brookdale Senior Living (Los Angeles, CA)
- …Greatest Workplaces for Diversity Brookdale Senior Living is hiring for a Director , Clinical Services Specialist supporting our communities in the greater Los ... In this pivotal role, you will oversee the day-to-day healthcare operations to ensure the highest quality of care...until a replacement is identified, then supports newly assigned Director of Clinical Services, Assistant Director of… more
- CommonSpirit Health (Rancho Cordova, CA)
- …professionals. Within an established framework, the manager assists the Region Director of RM&LP with developing, implementing and assessing the effectiveness of ... subject matter expert. + Assists with ensuring risk management activities for claims are completed including timely claim identification and reporting, on-site claim… more
- Evolent (Sacramento, CA)
- …sets you apart. Whether you're working with internal teams, external partners, or complex healthcare systems, your focus on building trust, delivering results, ... (3) years of provider relations, account management, and/or provider contracting, claims /reimbursement experience * Knowledge of healthcare , managed care,… more