- Humana (Sacramento, CA)
- …knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Humana (Sacramento, CA)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Evolent (Sacramento, CA)
- …and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Sacramento, CA)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of...MD review process to reflect appropriate utilization and compliance with… more
- Humana (Sacramento, CA)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Evolent (Sacramento, CA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Sacramento, CA)
- …Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. ... the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are… more
- CVS Health (Sacramento, CA)
- …has an exciting opportunity for a Medical Director (Spine) that can be remote based , work from home . The Medical Director (Spine) will be a Subject ... use of health care resources. **This is a remote based (work at home ) based ...including post-graduate direct patient care experience specifically. Expands Aetna's medical management programs to address member needs across the… more
- The County of Los Angeles (Los Angeles, CA)
- …activities that involve various healthcare sectors to include Ambulatory Surgery Centers, Home Health/Hospice and EMS Provider. + Develops medical surge ... SENIOR NURSING INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3309230) Apply SENIOR NURSING… more
- Evolent (Sacramento, CA)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...MD review process to reflect appropriate utilization and compliance with… more