- 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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Elevance Health (Costa Mesa, CA)
- …nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy ... care, eg, if services are not in line with diagnosis. + Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 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
- 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
- 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
- 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
- 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 ... of the manager of in-patient care management and the Director of Utilization Management. **Required Qualifications** + 3 Years...staff on at least a quarterly basis. + LeadershipManages UM operations in accordance with National Committee… 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
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