- Humana (Sacramento, CA)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... Medical 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
- Humana (Sacramento, CA)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- Highmark Health (Sacramento, CA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- BeOne Medicines (Emeryville, CA)
- …Director, Investigator-Initiated Trials (IIT) and Expanded Access Programs in Global Medical Affairs. The ideal candidate will be responsible for effective strategic ... require the ability to collaborate across other GMA functions and non- medical functions (eg, Marketing, Market Access, HEOR, Legal, Compliance, Regulatory, etc.).… more
- Fresenius Medical Center (Moreno Valley, CA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Highmark Health (Sacramento, CA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, member facing outreach initiatives… more
- Fresenius Medical Center (San Bernardino, CA)
- …Manager to oversee the facility's Home Therapies Program. * Maintains integrity of medical and operations records and complies with all data collections and auditing ... activities. *Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. *Manages clinic financials including… more
- Ventura County (Ventura, CA)
- …in-services and staff development programs; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; ... Registered Nurse II - Medical Surgical and Detox Department (Regular & Per...$108,312.24 - $144,806.19 Annually Location Ventura and may require travel throughout Ventura County, CA Job Type Various Job… more
- Humana (Sacramento, CA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health ... The Corporate Medical Director (CMD) relies on medical background to review health claims and...10-hour workdays per week, either Friday-Monday or Thursday-Sunday schedule. Travel : While this is a remote position, occasional … more
- Humana (Sacramento, CA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health ... part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate… more