- 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...data requires an in-depth evaluation of variable factors. The Medical Director relies on medical … 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...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Humana (Sacramento, CA)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... other weekend with compensated days off during the work week The Medical Director 's work includes reviewing of all submitted medical records, synthesizing… more
- Dignity Health (Bakersfield, CA)
- …across the managed care populations. This leader will have direct oversight of the Medical Director of Utilization Management ( UM ) and the Medical ... as providing clinical leadership and guidance to other physician medical directors within the UM department, ensuring...and Clinical Oversight functions. + Oversee and manage the medical director capacity to support Managed Care… more
- UCLA Health (Los Angeles, CA)
- …UCLA 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...do: + Lead the development, implementation, and training of medical policies. + Provide clinical determinations for UM… more
- LA Care Health Plan (Los Angeles, CA)
- …setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review. ... based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- Alameda Health System (Oakland, CA)
- Director , Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + FTE:1 + ... time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Molina Healthcare (San Bernardino, CA)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... Experience conducting Medi-cal reviews Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. *… more
- UCLA Health (Los Angeles, CA)
- Description We are seeking a highly skilled and dynamic Director of Clinical Services to lead the development, evaluation, and implementation of multiple clinical ... programs and medical services with an emphasis on optimizing Utilization Management...will: + Oversee the development and execution of multiple UM processes and workflows, while continuously identifying and evaluating… more
- Sharp HealthCare (San Diego, CA)
- … medical management activities to include tracking, trending and analyzing UM data. Works in collaboration with regional medical directors, ambulatory ... and hospital case management departments. Participates in the development of the annual UM plan and implementation of corrective action plans related to health plan… more