- Humana (Sacramento, CA)
- …Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to provide Humana members… more
- Elevance Health (Los Angeles, CA)
- **Behavioral Health Medical** ** Director -Psychiatrist** ** Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The **Medical Director ** is responsible for the administration of behavioral health medical services, to… more
- Evolent (Sacramento, CA)
- …the culture. **What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of...operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Elevance Health (Walnut Creek, CA)
- **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... employment, unless an accommodation is granted as required by law._ _A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management,… more
- Molina Healthcare (San Bernardino, CA)
- …setting. Contributes to overarching strategy to provide quality and cost-effective member care. Experience conducting Medi-cal reviews Essential Job Duties * ... program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- CenterWell (Sacramento, CA)
- …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...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
- Evolent (Sacramento, CA)
- …As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to ... medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management team. ... of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency… more