- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II Job Category:...clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses… more
- Sharp HealthCare (San Diego, CA)
- …Medical Management and Quality Improvement Director . + Oversees and mentors Medical Directors and Physician Reviewers. + Actively engages with SHC leaders ... employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and...Health Plan's (SHP) physicians ( Medical Directors (both medical and behavioral health) and the Physician … more
- Ventura County (Ventura, CA)
- …for employees of physician groups through the end of December 2022. Medical Director , Ventura County Health Care Plan Under general supervision of the ... matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff.… more
- Centene Corporation (Sacramento, CA)
- …state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician committees including committee ... and Medi-Cal experience, preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...and credentialing functions for the business unit. + Provides medical leadership of all for utilization management,… more
- Sharp HealthCare (San Diego, CA)
- …a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical Board ... + Provides professional leadership and direction to the functions within the Medical Management + Department ( Utilization /Cost Management and Quality Management)… more
- Humana (Sacramento, CA)
- …and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Evolent (Sacramento, CA)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... you will be a key member of the utilization management team. We can offer you a meaningful… more
- Evolent (Sacramento, CA)
- …per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be... management while working in conjunction with the Senior Medical Director . May assist the Senior … more
- Evolent (Sacramento, CA)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... you will be a key member of the utilization management team. We can offer you a meaningful… more