Medical Director Pm&R Or Internal Medicine - Remote UnitedHealth Group Inc.Medical Director Pm&R Or Internal Medicine - RemoteLos Angeles, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
NewUM Medical Director DME - Pacific Or Mountain Time Zone Preferred - Remote UnitedHealth Group Inc.UM Medical Director DME - Pacific Or Mountain Time Zone Preferred - RemoteLos Angeles, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
Medical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOCA$174,070–$374,920 / yearThe Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases.
NewMedical Director - Clinical Advocacy And Support - Remote - PST Preferred UnitedHealth Group Inc.Medical Director - Clinical Advocacy And Support - Remote - PST PreferredLos Angeles, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
NewMedical Director - Vascular Surgery - Remote UnitedHealth Group Inc.Medical Director - Vascular Surgery - RemoteLos Angeles, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
NewMedical Director - Sleep Medicine - Remote UnitedHealth Group Inc.Medical Director - Sleep Medicine - RemoteLos Angeles, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
Veterinarian Medical Director Trusted VetVeterinarian Medical DirectorTorrance, CaliforniaAs the medical director, you'll uphold and advance the hospital's medical protocol, guide and mentor associate veterinarians and partner with leadership on workflow efficiency. To ensure a healthy balance, administrative blocks will be built directly into your schedule to allow for quality time to be spent between each area of focus as the medical director.
Physician Urgent Care Medical Director Concentra Inc.Physician Urgent Care Medical DirectorCA$280,000–$330,000 / yearMonitors key clinical center metrics that are provided by Clinical Analytics and relate to quality outcomes: Practice Indicators, COP, GRV, LOS, TAT, Specialist Referral Rate, Primary Care Case Duration, Days to First Recheck, % of cases with Lost Time, Limited Duty, and Full Duty.• Manages clinicians and support staff and complies with APC supervisory requirements.• JOB-RELATED SKILLS/COMPETENCIES• Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility• Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions• Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism.
Regional Medical Director AltaMed Health Services CorpRegional Medical DirectorCA$348,247.42–$417,896.90 / yearAdditionally, this position shall be responsible for overseeing all clinical aspects of utilization management, case management, chronic disease case management, and all other areas necessary to facilitate the appropriate use of resources for senior patients and participants. The Regional Medical Director-PACE must be a clear and compelling communicator with a demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analysis and complex materials into compelling communications.
Medical Director, Utilization Management - Concurrent Review Blue Cross and Blue Shield AssociationMedical Director, Utilization Management - Concurrent ReviewWoodland Hills, CADemonstrated proficiency in at least 3 of the following: Medicare/Medicare STARS, Dual Special Needs Plan (D-SNP), Medi-Cal, NCQA/URAC/Quality Programs, Policies/Procedures development, Clinical Subject Matter Expert for Litigation, SIU/Waste/Fraud/Abuse, Appeals/Grievances, Case Management/Population Health, Federal Employee Program (FEP), Education/Training (delivers CME, CEU), Quality Improvement. Moreover, the Medical Director, Utilization Management - leads or meaningfully contributes to the Blue Shield priorities and transformative initiatives that continue to improve the health and wellbeing of Blue Shield of California members.
Medical Director, Utilization Management L.A. Care Health PlanMedical Director, Utilization ManagementLos Angeles, CAThis position plays a critical role in the mitigation of Fraud, Waste and Abuse (FWA) and requires proactive analysis of service level utilization data to identify trends, outliers and emerging risk areas and recommend corrective action to minimize utilization variation, prevent improper payments and ensure financial stewardship. Job Summary The Medical Director, Utilization Management provides clinical oversight of authorization decision making and processing, pre and post payment claims review activities, payment integrity clinical validation and program integrity functions.
Appeals Medical Director- Cardiology Elevance Health IncAppeals Medical Director- CardiologyWoodland Hills, CA$247,840–$446,112 / yearMinimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Associate Medical Director - Post Acute Care Elevance Health IncAssociate Medical Director - Post Acute CareWoodland Hills, CA$179,503–$307,732 / yearMinimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Medical Director MedTrainer IncMedical DirectorCAThe ideal candidate will be a licensed MD or DO with expertise in emergency cardiovascular care, resuscitation science, critical care, emergency medicine, cardiology, or a related specialty. For over 13 years, we have helped healthcare teams remain audit-ready and confident in their regulatory compliance through continuous innovation and deep industry expertise.
Associate Medical Director - Clinical Informatics University of CaliforniaAssociate Medical Director - Clinical InformaticsLos Angeles, CA$142,100–$348,100 / yearThe Associate Medical Director of Clinical Informatics develops and implements training programs with the Clinic's EMR trainers to train all VFC staff medical providers on electronic health records and health information technology used for direct patient care. The Associate Medical Director - Clinical Informatics is responsible for providing clinical leadership for health information technology at Venice Family Clinic (VFC) and provides clinical oversight of the implementation and maintenance of the electronic health record (EHR).
Medical Director - Medicare Advantage Blue Cross and Blue Shield AssociationMedical Director - Medicare AdvantageLos Angeles, CANecessary Contacts: department Managers, Authorization, Utilization Management, Case Management, Disease Management, Compliance personnel, and other employees as indicated, Licensed Doctors of Medicine (Physicians), Hospitals, and other healthcare providers, Parish and state medical agencies and societies as needed, Accreditation and governmental entities' personnel as needed. Fulfills medical director duties as appropriate which include but are not limited to: peer reviews, case reviews, completion of inter-rater reliability case reviews annually, active participation in training activities, provision of documentation to support compliance with annual licensure requirements, claims review to determine proper resolution, maintaining a working knowledge of company policies and procedures.
Clinical Director Eisner Health OpenClinical DirectorLos Angeles, CaliforniaMission: Since 1920, Eisner Health has operated as a quality-focused non-profit community health center dedicated to improving the physical, social, and emotional well-being of the people in the communities we serve. Eisner Health is seeking a Clinical Director who will supervise the licensed clinical staff within their department as well as provide direct care.
Field Medical Director, Vascular Surgeon Evolent Health IncField Medical Director, Vascular SurgeonCA$130–$140 / hourWhat You Will Be Doing: Serve as the specialty match reviewer in Vascular cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
Behavioral Health Medical Director - Psychiatrist - California Medicaid (Part-Time) Elevance HealthBehavioral Health Medical Director - Psychiatrist - California Medicaid (Part-Time)Woodland Hills, CA$178,135–$290,437.50 / yearMinimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Key responsibilities include monitoring and analyzing behavioral health trends within the health plan, serving as a clinical advisor and thought leader through ongoing collaboration with health plan partners, and providing support to behavioral health UM and case management teams beyond individual case reviews.
Critical Care Physician (Part Time Intensivist - Nocturnist) Sound Inpatient Physicians Holdings, LLCCritical Care Physician (Part Time Intensivist - Nocturnist)Long Beach, CACategorySelectAccountable Care OrgAccounting & PayrollAdvisory ServicesAnesthesiologyBusiness DevelopmentClinical LeadershipClinical SupportCritical CareEmergency MedicineHospital MedicineInformation TechnologyMedical DirectorNursingPeople TeamPost Acute / Transitional CareRevenue CycleSite AdministrationTelemedicine. Local Team Collaboration: Long Beach Memorial Medical Center is a 420-bed non-profit teaching hospital that has been recognized as a major regional provider of medical and surgical services by US News and World Report.