- Highmark Health (Sacramento, CA)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Conviva (Sacramento, CA)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- CVS Health (Sacramento, CA)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Double Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Centene Corporation (Sacramento, CA)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... of high-quality, cost-effective care to our members. This role further assists the Senior Medical Director or Chief Medical Officer in execution of strategic… more
- Cardinal Health (Sacramento, CA)
- …and Medicaid , including duplicate discounts, fee-for-service versus managed care, medical versus pharmacy, and entity-owned versus contract pharmacy settings + A ... an individual contributor role that reports to the Sr. Director of Clinical Operations. Candidates can live anywhere in...they navigate HRSA 340B audits. This support typically is remote but may require travel to the client location.… more
- Public Consulting Group (Sacramento, CA)
- …intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts + ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more
- Public Consulting Group (Sacramento, CA)
- …individual will support the public safety consulting business line, and other Medicaid and Medicare related projects. This role will use knowledge of fire/emergency ... medical services (EMS) standards, practical and clinical experience, and...departments and/or EMS agencies at the chief officer or manager/ director level. Provenexperience with people management, strategic planning, risk… more
- Public Consulting Group (Sacramento, CA)
- …support the delivery of health-related services by helping schools access critical Medicaid reimbursement. Client Success Partners (CSP) are key members of the ... PCG services. This position may report to either a SBS COE Client Success Director or a Client Success Lead. **Duties and Responsibilities** _Clients_ + Own and… more
- Centene Corporation (Sacramento, CA)
- …of services, to identify quality of care issues, and if identified, refer to the Medical Director or provider for review and verification + Consults with senior ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Humana (Sacramento, CA)
- …Lead, Marketing Campaign Management - Tech Enablement, to join the team working remote anywhere in the US. The Tech Enablement Lead role reports directly to ... the Director , Technology, Measurement, & Optimization and owns the successful...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more