- Alameda Health System (Oakland, CA)
- …time off plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, ... review policies and procedures in accordance with industry standards and regulatory requirements. Direct and coordinate data gathering and record keeping legally… more
- Ventura County (Ventura, CA)
- Medical Director , Ventura County Health Care Plan Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4924113) Apply Medical Director , Ventura ... Click here (http://tiny.cc/6vwi001) to view the Brochure for Medical Director , Ventura County Health Care Plan What We Offer...Plan, VCHCP is required to be compliant with all regulatory requirements of any other large insurance plan. The… 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...be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources… more
- Humana (Sacramento, CA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Sacramento, CA)
- …of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The ... Medical Director work assignments involve moderately complex to complex issues...be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources… more
- Humana (Sacramento, CA)
- …part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by… more
- Humana (Sacramento, CA)
- …part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by… more
- Datavant (Sacramento, CA)
- …our bold vision for healthcare. Datavant is seeking a strategic and hands-on ** Director of Quality** to lead product and supplier quality assurance efforts within ... Connect** and **Aetion Evidence Platform** . These platforms deliver regulatory -grade real-world data (RWD) solutions through tokenization, data linkage, and… 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. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national… 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 ... authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national… more
