- 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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. In this key ... leadership role, you'll work closely with the UHMAP Medical Director and play a vital part...policy that's grounded in the latest scientific research and Medicare guidelines. Your work will directly support our Health… more
- Centene Corporation (Sacramento, CA)
- …+ Managed Care and Medi-Cal experience, preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Molina Healthcare (San Bernardino, CA)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews… more
- Grifols Shared Services North America, Inc (Emeryville, CA)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- Gilead Sciences, Inc. (Foster City, CA)
- …lives of patients with life-threatening illnesses worldwide. We are hiring a **Senior Director Contracting Operations** to report to the Executive Director . This ... leadership team for Market Access Operations, reporting directly to the Executive Director . + Leads a team of 20+ professionals to drive operational excellence… more
- University of Southern California (Alhambra, CA)
- …Care Management Coordinators. 4. Makes appropriate referrals to supervisor or Medical Director , communicating accurate clinical information. 5. Participates in ... guideline (MCG and/or InterQual) competency testing as requested by department director or Medical Director . + Outcomes Management 1. Participates in core… more
- University of Southern California (Newport Beach, CA)
- …authorization request. The Specialist will be in a position to interface directly with medical /clinical staff and pharmacy to ensure a seamless process to the ... regarding enrollment and/or medication reimbursements + Communicate with a medical /clinical/ pharmacy staff and patients on authorization status/outcome. +… more
- CenterWell (San Diego, CA)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more