- HCA Healthcare (Riverside, CA)
- …corporate to train and support quality improvement, risk management, patient safety, case management, medical staff affairs, and physician relations activities + ... recommendations regarding how to reduce the variable cost per case while maintaining and enhancing clinical effectiveness + You...in a large, complex hospital or regional health system preferred + Current and clear medical licensure… more
- CVS Health (Sacramento, CA)
- …Qualifications** + 1+ years current or previous experience in Home Health + and/or Case Management experience preferred . + 1+ years experience with Lexicomp a ... This position consists of working intensely as a telephonic case manager with patients and their care team for...home position and all training is virtual.** Enhancement of Medical Appropriateness and Quality of Care: - Application and/or… more
- CVS Health (Sacramento, CA)
- …Qualifications** + 1+ years current or previous experience in Home Health. + and/or Case Management experience preferred . + 1+ years experience with Lexicomp a ... This position consists of working intensely as a telephonic case manager with patients and their care team for...team for fully and/or self-insured clients. + Enhancement of Medical Appropriateness and Quality of Care: + Application and/or… more
- Sharp HealthCare (San Diego, CA)
- …tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory care managers and hospital case management ... Degree Health care related field **Other Qualification Requirements** + Utilization, Case Management, or Quality Management certification preferred . **Essential… more
- Highmark Health (Sacramento, CA)
- …+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) ** Preferred ** + 1 year in Medical Management in a Health Insurance Plan; ... standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical...Preferred ** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral & Written… more
- 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 ... or data requires an in-depth evaluation of variable factors. Candidate must have valid Florida Medical license and must be able to start with 30-60 days of hire. The… more
- Datavant (Sacramento, CA)
- …for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to ... ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes + Accurately sequence and abstract medical codes from patient records, ensuring precision and adherence to documentation… more
- Humana (Sacramento, CA)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex to complex...participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute… more
- 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 ... situations or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the… more
- Ascendis Pharma (Palo Alto, CA)
- …mission of developing new and potentially best-in-class therapies to address unmet medical needs. Our culture fosters a place where skilled, adaptable, and highly ... for employees to grow and develop their skills. The Medical Director is involved in the design, monitoring, data...degree + Completion of ACGME-accredited residency and fellowship (strongly preferred ) + Physician licensure in at least one state… more