- Trustmark (Sacramento, CA)
- …the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner ... in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments.… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...member PHI / HIPAA information + This is a remote position\#LI- Remote **Scheduled Weekly Hours** 40 **Pay… more
- Merck (Sacramento, CA)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages ... questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific Congress Support, and… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement ... of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to improve quality… more
- Takeda Pharmaceuticals (Sacramento, CA)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...around the world. This position is currently classified as " remote " in accordance with Takeda's Hybrid and Remote… more
- Caris Life Sciences (Sacramento, CA)
- **Position Summary** The Director , Market Access Medical Policy is the expert in Caris Life Science Products and their clinical application for the Market Access ... needs to the internal clinical development team in order to improve product claims to obtain payer coverage. + Assist in collaborative efforts on health economic… more
- United Therapeutics (Sacramento, CA)
- …the pharmaceutical and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code, the Sunshine ... Compliance departments related to the Food Drug and Cosmetic Act, the False Claims Act, Anti-Kickback Statute, the Sunshine Act and other healthcare related laws and… more
- HealthEdge Software Inc (Sacramento, CA)
- **Overview** ** Director , Product Management** **Position Overview:** We are seeking a highly skilled and experienced Director of Product Management to lead our ... and QE. We have divided our product teams into Value Streams (ie, Claims , Billing & Financials, Enrollment, BlueCard, Integration, and Platform). Each Value Stream… more
- Western Digital (Sacramento, CA)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... requirements. + Insure the proper and efficient handling of claims as they relate to workers' compensation insurance requirements....to be performed in California, Colorado, New York or remote jobs that can be performed in California, Colorado… more
- HomeSafe Alliance (Sacramento, CA)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… 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
- Sedgwick (Sacramento, CA)
- …Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Risk Services Manager - Pooling ( Remote OR Hybrid in CA) **Are you looking for an impactful job where ... of an energetic culture?** + Enjoy flexibility -Hybrid in N. California (Sacramento), remote or telecommuter setting **in California only.** + This role will require… more
- Zurich NA (Sacramento, CA)
- …AM - Remote Work (US) Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-BN1 #LI- DIRECTOR #LI-HYBRID ... Zurich's Philadelphia office. We are also open to hiring remote talent. This role will be filled at either...and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance… more
- American Institutes for Research (Sacramento, CA)
- …to the analysis of healthcare data and provide support to the project director and/or senior team members on various tasks including querying large datasets ... including Medicare, Medicaid, and commercial payer claims data, cleaning and imputing data, creating analytic data files according to technical specifications,… more
- HomeSafe Alliance (Sacramento, CA)
- …with GHC pricing requirements and report actual performance monthly to the Director of International Operations (DIOps) + Verify and assess accuracy of transit ... risks of not meeting RDDs as directed by the Director of International Operations, for all shipments that may...International Operations, for all shipments that may create inconvenience claims for HomeSafe. Formats and data requirements to be… more
- American Institutes for Research (Sacramento, CA)
- …monitoring measures and audit protocols + Coordinate with programmer staff to implement claims -based and other measures + Work with subject matter experts to develop ... helping to design content for dashboards + Work with Project Director to prepare abstracts for research conferences **Qualifications** **Education, Knowledge, and… more
- Evolent (Sacramento, CA)
- …Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing ... prior authorization requests. Or relevant health care experience in claims or appeal & grievance is required. + Ability...while balancing a workload and prioritizing assignments in a remote environment. + The ability to connect to router… more
- CVS Health (Sacramento, CA)
- …care more personal, convenient and affordable. **Position Summary** This position is fully remote and employees can work from any state but must work the hours ... service delivery under the direction of nurse or medical director in the most appropriate setting at the most...- May assist in the research and resolution of claims payment issues. - Supports the administration of the… more
- Evolent (Sacramento, CA)
- …Opportunities to work collaboratively with other Clinical Operation Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing ... prior authorization requests and/or relevant health care experience in claims or appeal & grievance is required. + Previous...while balancing a workload and prioritizing assignments in a remote environment. + The ability to connect to router… more