- Humana (Sacramento, CA)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health ... and waiver requests. The Medical Director provides medical interpretation and determinations whether services provided...providers, clinical group practice management . + Utilization management experience in a medical management… more
- The County of Los Angeles (Los Angeles, CA)
- SENIOR NURSING INSTRUCTOR (EMERGENCY MEDICAL SERVICES ) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3309230) Apply SENIOR NURSING ... INSTRUCTOR (EMERGENCY MEDICAL SERVICES ) Salary $122,010.72 - $182,634.24 Annually...delivery of other EMS Agency classes including: Hospital Disaster Management Training (HDMT), The Medical Management… more
- Centene Corporation (Sacramento, CA)
- …changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national ... Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions... medical review of complex, controversial, or experimental medical services , ensuring timely and quality decision… more
- Humana (Sacramento, CA)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management . + Utilization management experience in a medical management review organization,… more
- Sharp HealthCare (San Diego, CA)
- …procedures.Review of out of area hospital and medical care services , and out-of-network department patient management .Interaction with case management ... finance issues related to appropriate level and location of patient services . + Provides medical knowledge, management and resource to assigned regional… more
- Travelers Insurance Company (Sacramento, CA)
- … capabilities to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon ... **What Is the Opportunity?** Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader medical … more
- Highmark Health (Sacramento, CA)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan;...**Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral &… more
- Elevance Health (Walnut Creek, CA)
- **Clinical Operations Associate Medical Director** **Carelon Medical Management ** **Outpatient Rehab Utilization Management ** **Virtual:** This role ... Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent... medical appropriate information in order to make medical necessity determinations for services requested. +… more
- CVS Health (Sacramento, CA)
- …implementation, and evaluation of clinical/ medical programs and promote Aetna's medical management programs and the Employer's (Plan Sponsor's) resources to ... across the continuum of care. You will support the Medical Management staff ensuring timely and consistent...health care providers to support the effective execution of medical services programs by the clinical teams.… more
- CVS Health (Sacramento, CA)
- …implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of ... care. You will support the Medical Management staff ensuring timely and consistent...providers and facilities to support the effective execution of medical services programs by the clinical teams.… more