• Medical Director - Medicare

    CVS Health (Sacramento, CA)
    …in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals : * Direct daily work on part C appeals (both provider and ... policy for the enterprise. * Provide ongoing education regarding Medicare policy and appeals to the appeal...Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
    CVS Health (10/31/24)
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  • Medical Director - Commercial…

    CVS Health (Sacramento, CA)
    …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals more
    CVS Health (11/14/24)
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  • Corporate Medical Director

    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. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
    Humana (11/27/24)
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  • Medical Director - Medical

    CVS Health (Sacramento, CA)
    …assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs....medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs… more
    CVS Health (11/22/24)
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  • Medical Director --Claims Management

    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 ... will 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 (10/29/24)
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  • Medical Director - Florida

    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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (12/14/24)
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  • Reviewing Medical Director

    Conviva (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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Conviva (12/11/24)
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  • Medical Director - Mid West Region

    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 ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
    Humana (10/29/24)
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  • Field Medical Director , Cardiology

    Evolent (Sacramento, CA)
    …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (11/15/24)
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  • Field Medical Director -Pulmonology

    Evolent (Sacramento, CA)
    …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (12/09/24)
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  • Manager Utilization Management

    Dignity Health (Rancho Cordova, CA)
    medical necessity; reviews and processes concurrent denials that require medical necessity determinations; processes appeals and reconsiderations. Act as a ... maintain effective team leadership and oversight. This role supports the UM Director in ensuring efficient operations with all processes, policies, strategies and… more
    Dignity Health (12/07/24)
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