Medical Director, Utilization Management

Your RoleThe Medical Management team at Blue Shield of California is dedicated to ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California. As the Medical Director, Utilization Management (CalPERS), you will report to the Vice President, Medical...

About the RoleThe Medical Director, Utilization Management plays a critical role in ensuring the delivery of high-quality, cost-effective healthcare services to our members. As a key member of the Blue Shield of California Medical Management team, you will be responsible for reviewing and making determinations regarding member and provider requests for...

Your RoleAs a key member of the Utilization Management team at Blue Shield of California, the Director, Medicare & Medi-Cal Utilization Management plays a critical role in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership.This individual will lead the development of UM...

Job SummaryThe Senior Utilization Management Nurse will be responsible for reviewing inpatient stays for our members under nationally recognized levels of care guidelines. This role requires a strong clinical background and excellent analytical skills to determine medical necessity of admissions, appropriate length of stay, and level of care.Key...

Job SummaryThe Senior Utilization Management Nurse will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare. This role requires a strong clinical judgment and...

Job SummaryThe Senior Utilization Management Nurse will play a key role in ensuring that members receive high-quality, cost-effective care. This position will be responsible for performing first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria.Key ResponsibilitiesPerform...

About the RoleThe Utilization Management Nurse, Senior will play a critical role in ensuring the quality and cost-effectiveness of healthcare services for our members.Key ResponsibilitiesConduct prospective, concurrent, and retrospective utilization reviews to determine medical necessity and ensure compliance with nationally recognized clinical...

Your RoleThe Medical Director, Operations (Behavioral Health) will report to the Senior Medical Director, Behavioral Health at Blue Shield of California. In this role, you will have core responsibilities in the areas of psychiatric inpatient concurrent review, pre- and post-service utilization review, and collaboration with Nurse Care Managers.Key...

Your RoleAs a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the highest quality care while minimizing unnecessary costs. You will be responsible for reviewing inpatient stays and applying nationally recognized levels of care guidelines to determine medical necessity.Your WorkConduct thorough reviews of...

Your RoleBlue Shield of California is seeking a seasoned leader to oversee the behavioral health program for all product lines. The Director of Behavioral Health will report to the Senior Director of Care Management.In this role, you will be the subject matter expert and leader for utilization management and case management behavioral health.Your WorkBe...

About the RoleThe Senior Medical Director, Behavioral Health will lead the Behavioral Health Medical Director team at Blue Shield of California. This role is responsible for providing clinical leadership and subject matter expertise in behavioral health. Key ResponsibilitiesProvide oversight of the clinical behavioral health program, including managing the...

Job Summary: We are seeking a highly skilled Nurse Practitioner Physician Assistant to collaborate with our medical director in overseeing medical services and medication-assisted treatment at Channell Family Medical Group.Responsibilities:Provide medical services in collaboration with the medical director.Offer consultation to patients.Collect and complete...

Job SummaryKimball Equipment is seeking an experienced Operations Director to oversee the company's operational management systems, processes, and best practices. The ideal candidate will have a strong background in organizational effectiveness and operations management, with experience in equipment dealership operations preferred but not required.Key...

Job SummaryWe are seeking a highly skilled and experienced Market Director, Facility Management to join our team at CommonSpirit Health. This is a key leadership role that will oversee the operations of our facilities management group/sites, ensuring that we meet all regulatory compliance and provide a safe and healthy environment for our patients and...

Job SummaryWe are seeking a highly experienced Market Director, Facility Management to join our team at CommonSpirit Health. This role will provide oversight and leadership to the Sacramento market, ensuring the financial, strategic, and operational goals of the organization are met.The successful candidate will serve as the connection between the assigned...

Senior Wealth Management SpecialistAt Franklin Templeton, we're driving our industry forward by developing innovative solutions to help our clients achieve their investment goals. Our dynamic and diversified firm spans asset management, wealth management, and fintech, offering a range of opportunities to help investors make progress toward their...

Job SummaryAs a Quality Assurance Director at Demo - Maximus, you will be responsible for developing and implementing quality assurance systems and goals to ensure compliance with contractual and regulatory requirements. You will work closely with the Department of Health Care Services to develop and maintain positive and effective communications.Key...

Job SummaryApplied Palliative and Hospice Services, Inc. is seeking a highly skilled Marketing Director to lead our marketing efforts and drive business growth. The ideal candidate will have a strong background in healthcare marketing and a proven track record of success in developing and implementing effective marketing strategies.Key...

Job Title: Senior Project DirectorOverview:RMA Companies is a leading provider of testing, inspection, and certification services. We are passionate about contributing to the sustainable development of the communities we serve.Job Description:As a Senior Project Director, you will be responsible for ensuring projects are tracked to all project metrics such...

Job Title: Veterinary Medical DirectorOur organization is seeking a highly skilled and compassionate Veterinary Medical Director to join our team. As a key member of our leadership team, you will be responsible for providing exceptional medical care to our patients and leading our team of veterinarians.Key Responsibilities:Provide high-quality medical care...