- Rady Children's Hospital San Diego (San Diego, CA)
- …accountable for establishing quality standards and measuring outcomes as directed by the RCHN Senior Medical Director , and VP, Network Ops & Clinical ... is part time with full benefits with a remote work option. The Medical Director , UM is a clinical subject-matter expert for the Utilization Management… more
- Evolent (Sacramento, CA)
- …to both members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director ... and write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet all accreditation,… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...+ Achieves and maintains benchmarked utilization and cost management ( UM ) goals and clinical quality improvement (QI) objectives, in… more
- Evolent (Sacramento, CA)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process improvement and enhancement of… more
- Sharp HealthCare (San Diego, CA)
- …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical ... **Shift Start Time** **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours** **:** **Shift Start… more
- Sutter Health (Burlingame, CA)
- …with care management, UM staff and health care team members and medical directors of third-party payers to discuss the needs of patient's and alternative levels ... regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial… more
- LA Care Health Plan (Los Angeles, CA)
- …the Regulatory Compliance unit, the Advisor also advises and supports the Manager, Director , and Chief Compliance Officer on other duties as assigned to support the ... and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management ( UM ) and so forth) and developing audit tools. Demonstrated experience… more