- CenterWell (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations,… more
- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… 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 ... Medical Director work assignments involve moderately complex to complex issues...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- CVS Health (Sacramento, CA)
- …day. **Position Summary** Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a ... anywhere in the United States. In this role as Medical Director MPO ( Medical Policy...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. Schedule: Fulltime position, Monday through Friday. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- Merck (Sacramento, CA)
- **Job Description** Associate Director , Field Access Management The Associate Director , Field Access Management serves as the leader to a team of subject-matter ... of patient enrollment process, payer coverage policies, prior authorization process, appeals process, patient support programs, and Hub operations to Field Access… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to the Executive Officer of… more
- University of Southern California (Alhambra, CA)
- …ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare, Medi-Cal, MAC, RAC, and commercial insurance companies -when there is refusal or rejection to honor ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier… more
- Sacramento County (Sacramento, CA)
- …Building Inspector series review construction plans, and/or inspects all residential, commercial , industrial buildings, and other structures in Sacramento County to ... duties which have included reviewing construction plans and inspecting residential, commercial , and/or industrial buildings to determine compliance with local, state… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... or networks. Essential Duties: 1. Configures, maintains, enhances and supports commercial software packages, internally developed applications and web services. 2.… more
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