- Elevance Health (Costa Mesa, CA)
- ** Medical Director - Medicare and Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... required by law. **Candidates must live in California.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market… more
- Humana (Sacramento, CA)
- …management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience ... caring community and help us put health first** The Medical Director relies on medical ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products +… more
- Humana (Sacramento, CA)
- …SNF, DME, dual Medicare / Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Humana (Sacramento, CA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director relies on medical ...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- Humana (Sacramento, CA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director actively uses their medical...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- Humana (Sacramento, CA)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Evolent (Sacramento, CA)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more
- Evolent (Sacramento, CA)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more