Current jobs related to Medical Director, Operations - el dorado hills - Blue Shield of California
-
Director, Operations
2 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Payment Integrity & Corporate Recovery team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. It encompasses determining the correct party, membership eligibility, contractual adherence, and fraud, waste and abuse detection and prevention. This team is responsible for over $400M+ of...
-
Director, Operations
4 weeks ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Payment Integrity & Corporate Recovery team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. It encompasses determining the correct party, membership eligibility, contractual adherence, and fraud, waste and abuse detection and prevention. This team is responsible for over $400M+ of...
-
Medical Director
2 days ago
El Dorado, CA, United States Premise Health Full timePremise Health is seeking a full time Medical Director to provide primary care and clinical leadership with our employer based direct care clinic in Folsom, CA ***$25k Sign-on Bonus*** What makes this opportunity unique: Practice evidence based medicine where you are not paid for production Bottom line is measured by the quality of patient care...
-
Medical Office Coordinator
1 week ago
El Dorado Hills, California, United States Medical Professionals Full timeJoin Our Team at Medical ProfessionalsAbout UsMedical Professionals is a reputable medical clinic serving the community since 1985. We are a single-specialty group dedicated to the treatment of diseases in the digestive tract and liver.Our MissionWe practice old-fashioned medicine by treating our patients with compassion and respect. Our team of medical...
-
Medical Office Coordinator
2 weeks ago
El Dorado Hills, California, United States Medical Professionals Full timeJoin Our Team at Medical ProfessionalsAbout UsMedical Professionals is a reputable medical clinic serving the community since 1985. We are a single-specialty group dedicated to the treatment of diseases in the digestive tract and liver.Our MissionWe practice old-fashioned medicine by treating our patients with compassion and respect. Our team of medical...
-
Senior Operations Manager
2 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeJob Summary:The Provider Operations & Credentialing team at Blue Shield of California is accountable for managing compliance to both regulatory and business requirements for our contracted provider universe. As a key member of this team, the Senior Operations Manager will report to the Senior Director of Provider Operations.Key Responsibilities:Manage...
-
Business Operations Specialist
1 day ago
El Dorado Hills, California, United States Blue Shield Of California Full timeAbout the RoleThe IT Business Operations team at Blue Shield of California is a trusted partner that enables the Information Technology organization to become a business-oriented, product-led, Agile organization.The Administrative Assistant, Specialist will report to the Sr. Director of IT Business Operations and will play a critical role in supporting the...
-
Medical Director
2 days ago
El Dorado, CA, United States Premise Health Full timePremise Health is seeking a full time Medical Director to provide primary care and clinical leadership with our employer based direct care clinic in Folsom, CA ***$25k Sign-on Bonus*** Practice evidence based medicine where you are not paid for production Bottom line is measured by the quality of patient care Less paperwork and administration time...
-
El Dorado, Arkansas, United States Enterprise Medical Recruiting Full timeMedical Center Opportunity in South ArkansasWe are seeking a highly skilled Family Medicine Physician to join our team at a Medical Center in South Arkansas. This is an excellent opportunity for a physician to practice outpatient medicine in a strong hospitalist program.Key Highlights:Outpatient practice onlyStrong hospitalist program for patientsMultiple...
-
Senior Operations Manager
3 weeks ago
El Dorado Hills, California, United States Blue Shield of California Full timeYour RoleThe Provider Operations & Credentialing team is responsible for ensuring adherence to both regulatory and business standards for our network of contracted providers. The Senior Operations Manager will report directly to the Senior Director of Provider Operations & Credentialing.In this capacity, you will act as the primary custodian for maintaining...
-
Senior Operations Manager
3 weeks ago
El Dorado Hills, California, United States Blue Shield Of California Full timeYour RoleThe Appeals and Grievances division is dedicated to addressing our members' concerns through a structured process that ensures each issue is handled accurately, promptly, and in compliance with regulations. The Senior Operations Manager will report directly to the Senior Director of Operations. In this capacity, you will lead and support your team...
-
Plant Operations Director
3 days ago
El Dorado, Arkansas, United States Continental Carbonic Products, Inc. Full timePlant Manager Job DescriptionThe ideal candidate will possess experience in managing both a production facility and a team. They should be able to analyze each step of the manufacturing process and make effective use of resources to deliver desired outcomes. The candidate will also have the ability to follow safety and compliance guidelines diligently in...
-
Enterprise Value Streams Director
6 days ago
El Dorado Hills, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly experienced and skilled Director to lead our Enterprise Value Streams initiative. As a key member of our IT Business Operations team, you will be responsible for driving the launch of Agile Release Trains (ARTs) and Value Streams across the enterprise.Key ResponsibilitiesDrive the implementation of Agile delivery...
-
Enterprise Value Streams Director
9 hours ago
El Dorado Hills, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly experienced and skilled Director of Enterprise Value Streams to join our team at Blue Shield of California. As a key member of our IT Business Operations team, you will play a critical role in driving the adoption and maturity of Agile methodologies across the enterprise.Key ResponsibilitiesDrive the launch of Agile...
-
Workforce Management Director
2 weeks ago
El Dorado, Arkansas, United States Murphy USA Full time**Job Summary**At Murphy USA, we are seeking a highly skilled and experienced professional to fill the role of Workforce Management Director. This is a critical position that requires a strong understanding of workforce management principles and practices.**Key Responsibilities**Develop, monitor, and report on workforce management systems to ensure optimal...
-
Operations Manager
2 weeks ago
El Dorado, Arkansas, United States Murphy USA, Inc. Full time**Job Summary**At Murphy USA, Inc., we are seeking a highly skilled and experienced Workforce Management Director to join our team. As a key member of our operations team, you will be responsible for managing the workforce management function and staff for our organization.**Key Responsibilities**Oversee the maintenance, development, and reporting of our...
-
Operations Manager
2 weeks ago
El Dorado, Arkansas, United States Murphy Oil Full timeJob SummaryMurphy USA is seeking a highly skilled Workforce Management Director to lead the workforce management function and staff. The successful candidate will be responsible for the maintenance, development, and reporting of the workforce management system.Key ResponsibilitiesDevelop, monitor, and report on workforce management system - WMF.Identify...
-
Medical Director
1 week ago
El Centro, California, United States Imperial Detention (Medical) Full timeJob SummaryWe are seeking a highly skilled Nurse Practitioner to join our team at Imperial Detention (Medical) in El Centro, CA. As a key member of our healthcare team, you will provide high-quality patient care and work collaboratively with our medical staff to ensure the best possible outcomes for our patients.Key ResponsibilitiesProvide direct patient...
-
Operations Director
3 weeks ago
El Paso, Texas, United States At Home Full timeJob Summary:The Operations Director is responsible for overseeing store processes and supporting an active selling culture by ensuring that all aspects are maintained to documented company standards designed to drive sales. This role provides expertise in all operation processes including opening, closing, training, and delegation of tasks while always...
-
Director of Nursing Operations
3 weeks ago
El Paso, Texas, United States The Hospitals of Providence - Sierra Campus Full timeJob SummaryThe Assistant Director of Cath Lab Services is a professional nurse who manages the daily operations of a department(s) with the Director of Nursing to provide services for patients while meeting quality, legal, organizational and medical staff goals. The Assistant Director is responsible for supporting the Director of Nursing by promoting the...
Medical Director, Operations
4 months ago
The Medical Director, Commercial is a key member of the Medical Management and Operations staff within Health Care Services. This is a front-line utilization management position that has core responsibilities in the areas of pre and post service utilization review, and collaboration with RN Case and disease managers. This director position will report to the Medical Director of Medical Operations.
Be the medical decision-maker and support for the prior authorization registered nurse (RN) team, facilitating appropriate use of resources, including safe and timely decisions. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers
The Medical Director will review pre- and post-service requests and render decisions based on the member’s benefits, medical necessity, Blue Shield of California medical policy as well as legal and regulatory requirements. The Medical Director must be well-versed in most areas of medicine, show ability for rapid, accurate decision-making, and enjoy care review and the investigation and resolution of complex issues. Experience with CPT coding, medical claims review, hospital billing, and reimbursement is a core competency
The Medical Director will participate in projects and committees as necessary
Conduct problem analysis and clinical decision-making, which are the most critical skills, including the ability to independently formulate and implement solutions
Possess clear, compelling communication skills with demonstrated ability to motivate, guide, influence and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications
Possess essential listening, interpreting, negotiating, and consensus building skills to bring business conflicts to successful resolution
Understand overall managed care organization, business strategies, and financial metrics; Lead and provide training and guidance to others
A minimum of 5 year's experience in active clinical practice in an adult-based primary care specialty (preferably Internal Medicine or Family Practice) is required
A minimum of 3 years of experience working for a Medical Group, IPA, or Health Plan making decisions for Medicare Advantage utilization is preferred but not required Active recent hospital experience (within the past five years) is desirable. Strong clinical skills with prior experience in a primary care setting
A medical degree (MD or DO) with five or more years of clinical experience, preferably in a managed care setting with hospital experience, since a large part of this position involves inpatient con-current review
Unrestrictive license to practice medicine in the State of California
Board certified in a in a recognized medical or surgical specialty (preferably Internal Medicine)
