Medicare Medical Director Utilization & Care Oversight
$223.8k - $313.1kHumana
Humana Inc. in Sacramento is seeking a Medical Director to oversee clinical policies and authorization processes regarding Medicare and Medicare Advantage services. You will leverage your clinical judgment to navigate complex cases, ensuring compliance with guidelines and regulatory standards. The ideal candidate will have an MD or DO, relevant experience, and demonstrated skills in conflict resolution. Flexible working options available, and competitive compensation range from $223,800 to $313,100 annually. #J-18808-Ljbffr
- ...transforming health care delivery for Blue... ...the Promise Chief Medical Officer (CMO) and its Medical Directors report up to the... ...Medical Director, Utilization Management. The... ...'s duties include oversight and management of... ...following: MEDICARE/MEDICARE STARS...SuggestedWork at office
- ...Your Role The Medical Management team ensures... ...a value-based health care system in California. The Medical Director, Utilization Management - will report... ...will assist in clinical oversight of coordination of... ...least 3 of the following: Medicare/Medicare STARS, Dual...SuggestedFull timeWork at office
$286.33k
...leadership with a focus on optimizing performance in care progression, clinical documentation integrity (CDI), utilization review/management, and clinical revenue cycle... ...: ~ Doctorate: Graduate of an accredited medical school CERTIFICATION & LICENSURE: ~ MD-Doctor...SuggestedFull timeWork at officeMonday to FridayShift workWeekend work$176.6k - $294.3k
...ROLE SUMMARY The Specialty Care Field Medical Director, Non-MD is responsible for providing therapeutic... ...boards (BRF, Vendor) with manager oversight. Field relevant inbound queries... ...technical skills Rapidly adopt and utilize new digital technology and other resources...SuggestedPermanent employmentH1bLocal areaRemote workVisa sponsorshipWork visaRelocation packageFlexible hours$223.8k - $313.1k
...Become a part of our caring community The Medical Director National OP Medicare relies on medical background and reviews... ...Advantage requirements in daily utilization management and coverage determination... ...resource utilization. Provide oversight or input, as applicable,...SuggestedBi-weekly payFull timeTemporary workApprenticeshipRemote workWork from homeHome office$234.63k - $336.6k
...Job Description The Medical Management team ensures... ...on the cutting edge of utilization management reimagined to... ...of a value-based health care system in California. The Medical Director, Utilization Management... ...for BSC Commercial and Medicare members. These functions...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week- ...Pediatric Associate Medical Director to provide both clinical... ...direct patient care with medical management... ...responsibilities Oversight of pediatric clinical... ...Oversight of referral utilization and specialty care access... ...Ability to obtain Medicare, Medi-Cal, and commercial...Permanent employmentFull timeLocumMonday to FridayFlexible hours
$223.8k - $313.1k
...Overview Become a 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... ...Intermediate to advanced skills utilizing Microsoft Office and Internet navigation...Full timeTemporary workApprenticeshipWork at officeRemote workWork from homeMonday to Friday$223.8k - $313.1k
...Become a part of our caring community The Behavioral Health Medical Director is responsible for behavioral health care... ...Health Medical Directors will learn Medicare, Medicare Advantage and... ...focusing on quality management, utilization management, case management, discharge...Bi-weekly payFull timeTemporary workApprenticeshipRemote workWork from homeHome officeWeekend work$186.2k - $363.09k
...DESCRIPTION Job Summary Provides medical oversight and expertise in... ...receive the most appropriate care in the most effective setting... ...members. • Supports plan utilization management program and accompanying... ...Facilitates conformance to Medicare, Medicaid, NCQA and other...Work experience placementWork at officeLocal area$223.8k - $313.1k
...Become a part of our caring community The Medical Director relies on medical background and reviews health... ...Medicine, or those experienced in Utilization Review are encouraged to apply.... ...utilization management or inpatient review (Medicare Advantage, Managed Medicaid, or...Bi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeHome officeMonday to FridayWeekend work- ...Opportunity Information Sutter Medical Group seeks to hire a highly qualified and passionate Pediatric Critical Care Medical Director for Sutter Medical Center Sacramento Children... ...focused services. Leadership & Program Oversight: Communication & Collaboration...Summer workLocal areaRelocation packageFlexible hours
- ...Supervisor, Pharmacy Care Delivery, Clinical Pharmacy In addition to the responsibilities... ...complex direct patient care, drug utilization, and educational programs related to... ...may also provide direct patient care for medication initiation, medication selection, dosage...Internship
- ...Physician, Pediatric Critical Care Medical Director (Sacramento, CA) Description Sutter Medical Group seeks to hire a highly qualified and... ...and other pediatric ‑focused services. Leadership & Program Oversight Communication & Collaboration Foster strong, trusting relationships...Local areaRelocation packageFlexible hours
$122.3k - $158.9k
...About the job Clinical Supervisor RN - Recuperative Care (Medical Respite) About WellSpace Health: WellSpace Health is the... ...populations. What You'll Do: - Provide clinical leadership and oversight to a team of 2 LVNs and 8-12 Clinical Support Specialists -...Flexible hours$140k - $160k
...HIRING! for a Hospice Director of Patient Care Services near Stockton CA. and we are offering relocation... ...Care Services (DPCS) provides oversight and support of all patient care and associated... ...Income paid out Quarterly. Benefits: Medical, Dental Vision Insurance (80% of...Live inRelocation package$126.36k - $140.6k
...looking for a compassionate clinical leader to ensure quality patient care and guide a clinician team. With responsibilities including... ...offered, alongside a $10K sign-on bonus and comprehensive benefits including medical coverage and retirement plans. #J-18808-Ljbffr...Relocation package- ...enrolled participants. The Center Medical Director provides medical care for InnovAge PACE enrolled... ...Director is also responsible for oversight of day-to-day medical operations at... ...department budget, quality initiatives, utilization and resource management. Physical...Temporary workLocal areaRelocation packageMonday to FridayFlexible hoursNight shiftWeekend work
- ...organization that has engaged in health care quality consulting and quality improvement... ...'s why we offer benefits that include: Medical, dental and vision insurance Paid time... ...supervision of clinical staff who conduct utilization review and/or specialty reviews. The...Contract workRemote work
- ...divh2Clinical Care Manager CA/h2pWe are seeking a Clinical Care Manager CA to join our... ...care plans for patients with complex medical needs./liliCoordinate communication among... ...case management teams to optimize resource utilization./li/ul/div Independent Living Systems,...
- ...Ascension St Vincent in Sacramento, CA is looking for a Pediatric Critical Care Medical Director to lead clinical operations at the Pediatric Intensive Care Unit. The role includes overseeing clinical quality, operational effectiveness, and strategic growth. You will work...Relocation package
- ...Inspire Health Alliance is seeking a Pediatric Critical Care Medical Director to oversee clinical operations and lead the strategic growth of the PICU/CVICU at Sutter Medical Center Sacramento Children's Center. This role demands collaboration with multidisciplinary teams...
$176.6k - $294.3k
...The Oncology Field Medical, Director is responsible for providing therapeutic... ...(BRF,Vendor) with manager oversight. Field relevant inbound... ...and evolving external health care environment Demonstrate change... ...skills Rapidly adopt and utilize new digital technology and...Permanent employmentH1bLocal areaRemote workVisa sponsorshipWork visaRelocation packageFlexible hours- ...Concentra in California is looking for a Medical Director to provide direct patient care while managing clinic operations. This role blends a passion for patient care with leadership in a collaborative environment. Enjoy competitive compensation up to $300K with incentives...
- ...Nahse seeks a qualified Medical Pediatric Hematologist/Oncologist Director in Sacramento, CA, to lead our pediatric hematology and oncology program while engaging in direct patient care. This role combines visionary leadership with clinical responsibilities, including...Flexible hours
- ...Ascension St Vincent is seeking a Pediatric Hematology/Oncology Medical Director in Sacramento, CA. This leadership role involves overseeing... ...hematology and oncology program while actively practicing clinical care. Candidates should possess an MD or DO with board...
$220k - $240k
...South Sacramento Pet Hospital is looking for a skilled Medical Director Veterinarian to provide high-quality veterinary care in Sacramento, California. The ideal candidate will have excellent communication skills and a commitment to compassionate care, overseeing a team...Relocation package$70.66k - $115.63k
Behavioral Health Care Manager I A proud member of the Elevance Health family of companies... ...assess member needs to ensure access to medically necessary quality behavioral healthcare... ...Qualifications Previous experience in utilization management with a broad range of...Full timeContract workWork experience placementWork at officeLocal area$220k - $240k
...Accreditation Council for Graduate Medical Education is looking for a Medical Director Veterinarian in Sacramento, California. This role requires a strong commitment to high-quality veterinary care and excellent communication skills to build relationships with clients...$27.97 - $34.78 per hour
...clerical functions for the nursing station; coordinates patient care activities with other departments to include programming and... ...experience working in a similar setting. Ability to utilize relevant medical terminology. Ability to effectively communicate and provide...Hourly payContract workTemporary workWork at officeLocal areaFlexible hoursShift workNight shiftAfternoon shift
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