- Humana (Sacramento, CA)
- …Director relies on medical background and reviews health claims and preservice appeals . 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… more
- Elevance Health (Sacramento, CA)
- …Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are ... for medical necessity. + Extrapolates and summarizes medical information for medical director ,...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
- Highmark Health (Sacramento, CA)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Sacramento County (Sacramento, CA)
- …court decisions including Civil Rights Act, Americans with Disabilities Act, Family Medical Leave Act, California Family Rights Act, Pregnancy Disability leave, Fair ... Free Workplace Act + Principles and methods for investigating and resolving grievances and complaints + Principles and practices of organizational behavior and… more
- Sacramento County (Sacramento, CA)
- …of acute and chronic illnesses, and their treatment + Family planning methods + Medical and health care for pregnant women + Normal growth and development, and ... common illnesses of infants and children + Standard medical record-keeping + Procedures, techniques, and tests for conducting...of the total possible score as determined by the Director . APPEAL PROCESS: Persons who believe their applications have… more
- Sacramento County (Sacramento, CA)
- …flexible spending account options for dependent care and unreimbursed dental and/or medical cost; and an employee assistance program (EAP). GENERAL BENEFITS: Most ... a pre-tax basis via payroll deduction, to pay for medical , dental or dependent care expenses. + DEPENDENT CARE...of the total possible score as determined by the Director . APPEAL PROCESS: Persons who believe their applications have… more