- Provider Solutions & Development (Torrance, CA)
- Providence Little Company of Mary is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Torrance, ... our mission outcomes. You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular the CMO, CNO, and… more
- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor/ UM Medical Director to join a strong leadership team promoting high-value care in Mission ... mission outcomes. You will work closely with the physician leadership, the Director of Care Management, and executive leadership; in particular the CMO, CNO,… more
- Humana (Sacramento, CA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… 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 ... month with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex… more
- LA Care Health Plan (Los Angeles, CA)
- …cost cases and reports are maintained and referred to the Physician Advisor/ UM Director . Document in platform/system of record. Utilize designated software ... and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group or management… more
- Sharp HealthCare (San Diego, CA)
- …or services, readmissions to acute or visit to the Emergency Department.Informs Director , QI/ UM of any quality issues.Attends hospitalists rounds, as required, ... for medical necessity are issued under the direction of the Medical Director or designee.Assists with transfers, when necessary. + Demonstrates knowledge of… more
- Dignity Health (Bakersfield, CA)
- …authorization requests, gathering necessary information, and escalating to the Medical Director when needed. - Compliance & Accuracy: Meeting turnaround times and ... service in line with CommonSpirit's values. You will function as a UM nurse reviewer, applying clinical expertise to ensure appropriate healthcare utilization. This… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our plan. In this ... key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services functions. Your… more
- Evolent (Sacramento, CA)
- …Be Doing:** **What You'll Be Doing:** Evolent is seeking an experienced Managing Director of Product Management to help Evolent grow by partnering with Payers to ... 'jobs to be done' and practice workflows, with a preference for expertise in UM workflows + Exceptional verbal and written communication skills, with the ability to… more