- Humana (Sacramento, CA)
- …ensuring attainment of quality of care and financial goals. The Behavioral Health Medical Directors support Humana values, and Humana's Bold Goal mission, ... 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… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and… more
- VCA Animal Hospitals (Sacramento, CA)
- …team to deliver a consistent message to staff and clients regarding patient care, case management and medical standards. Along with the RMD, gives associate ... practices in Northern California, is looking for a **Specialty Medical Director** to lead our growing team. VCA SVRC...every morning with all the doctors to discuss hospitalized case with our intern class as a learning opportunity.… more
- Highmark Health (Sacramento, CA)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... treatment of service. Depending on the nature of the case , telephonic peer to peer discussions may be required....the incumbent may be assigned special projects to help support and improve the care of our members **ESSENTIAL… 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
- BluePearl (Del Rey Oaks, CA)
- …**Why Choose BluePearl Monterey?** + **Collaborative Medicine:** Strong cross-departmental case management and support + **Existing Specialty Services:** ... quality of life. **What You'll Do as Medical Director:** + Uphold medical quality standards and patient safety + Support hospital operations and team… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …other mental health practices to provide patients and families with assessment interventions, support , advocacy and case management as a primary provider and/or ... an independent practitioner or as a member of a medical team. Also may provide support and...practices to provide patients and families with assessment, interventions, support , advocacy, and case management as a… more
- Datavant (Sacramento, CA)
- …EST * Comfortable working in a high-volume production environment. * Processing medical record requests by taking calls from patients, insurance companies and ... attorneys to provide medical record status * Documenting information in multiple platforms...reviewed by Datavant Human Resources and determined on a case -by- case basis. Depending on the state in… more
- Providence (CA)
- …to address coverage + Set appropriate indemnity and expense reserves + Select appropriate medical experts for case review + Develop a plan of action for ... must empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, evaluate, and manage professional,… more
- Sumitomo Pharma (Sacramento, CA)
- …individual for the position of **Associate Medical Director.** The Associate Medical Director will provide hands-on PVRM support for SMPA investigational and ... commercial products. The incumbent will provide medical safety support for safety signal management...requirements** + Expertise in medical review of medical review of Individual case safety reports… more
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