- 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 an ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Sacramento, CA)
- …Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds… 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 an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Sacramento, CA)
- …Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...Prefer Medical Oncology or Surgery specialties + Utilization management experience in a medical… 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 an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req ... Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... individual 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… more
- Prime Healthcare (Inglewood, CA)
- …director -of-case- management utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital ... Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Director of Case Management is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...requests by Providers. Acts as a department resource for medical service requests /referral management and processes.… more
- Stanford Health Care (Palo Alto, CA)
- …Facilities, Durable Medical Equipment vendors) in collaboration with Contract Management and Legal Affairs. + Assists Director in designing, implementing, ... Health Care (SHC)? - Recognized as a top Academic Medical Center globally! - Ranked No. 10 on the...leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by… more
- Ventura County (Ventura, CA)
- …communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality ... Medical Director , Ventura County Health Care...procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for ... professional leadership and direction to the functions within the Medical Management Department ( Utilization /Cost ...Program and Quality Improvement Program, in conjunction with the Director of PHM/ Medical Management … more
- Molina Healthcare (CA)
- …information from authorization requests or for additional information as requested by the Medical Director . Must have: Medical terminology **ICD 10 code ... Experience** 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred. To all current Molina employees: If you are… more
- Centene Corporation (Sacramento, CA)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. ... + Provides medical leadership of all for utilization management , cost containment, and medical...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Molina Healthcare (San Bernardino, CA)
- …, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk ... resource management . + Develops and implements a Utilization Management program and action plan, which...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- LA Care Health Plan (Los Angeles, CA)
- …operational systems and tools while also performing utilization review of cases. The Medical Director reports to the Senior Medical Director , ... Medical Director , Community Health Job Category:... review of cases and participates in our care management programs periodically. Provide utilization review and… more
- Magellan Health Services (San Diego, CA)
- …Clinical Center of Excellence. + Provides clinical leadership to the interdisciplinary Medical Management team, which includes clinical/ medical oversight of ... case management and timely completion of all utilization management activities. Involvement in the development...activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May… more
- Providence (Santa Monica, CA)
- **Description** **THE ROLE** The Director , Case Management promotes and supports the mission, vision and objectives of Saint John's Health Center and is ... line through strategic plans/policies, in collaboration with CMO, Administrative Director , Safety and medical /program directors. Implements strategies that… more
- Evolent (Sacramento, CA)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Alameda Health System (Oakland, CA)
- Director , Inpatient System Care Management + Oakland, CA + Highland General Hospital + SYS Care Coordination + Full Time - Varies + Management + Req ... Alameda Health System is hiring! Under the direction of the Vice President of Care Management , the Director of Inpatient System Care Management manages the… more