Top 52 Program manager Jobs in Redding, Ca

Family Medicine Medical Director Utilization Management
Amerihealth Caritas —United States
- Weekends as needed
- Hybrid work
- Medicine
- Physical & Rehabilitation Medicine
- 3 years
- Paid holidays
- Health insurance
Nurse Practitioner (Remote, Full-time)
SteadyMD —United States
- $100,000 - $120,000 a year
- Weekends as needed
- Remote
- Urgent Care
- Adults
- Mid-level
Quick Apply
Inpatient Medical Coding Quality Auditor
Pena4 Inc. —United States
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- 5 years
- US work authorization
- Senior level
- Health insurance
- Dental insurance
Quick Apply
3d

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Jubilee College - Director of Operations & Programs
Strategenius on behalf of Jubilee College —Dunsmuir, CA
The Director of Operations & Programs will own the project management and execution of Jubilee's operational infrastructure, building the administrative systems…
$80,000 - $90,000 a year
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Unit Management Human Services Program Administrator 2
State of Ohio - Youth Services - Central Office —Columbus, OH
Or completion of graduate core program in social or behavioral science, medicine-related field or public or business administration or accounting; and 12 mos.
$36.75 - $52.27 an hour
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Ohio Children's Alliance - Senior Manager, Programs
Ohio Children's Alliance —Columbus, OH
Lead the planning, implementation, and evaluation of assigned programs or initiatives; develop and oversee work plans, timelines, and performance metrics;…
$80,000 - $90,000 a year
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Family Medicine Medical Director Utilization Management

Amerihealth Caritas -
United States

Apply Now

Job Details

Full-time

Benefits

Paid holidays
Health insurance
Tuition reimbursement
Paid time off

Qualifications

Utilization management
Medical License
Productivity software

Full Job Description

In this role, you will lead the operational areas of the Utilization Management (UM) program including prospective, concurrent, and retrospective reviews. As a Medical Director, UM you ensure all patient care decisions and referrals are medically appropriate by using national and local criteria. Our Medical Directors, UM help develop and implement medical policies, procedures, and clinical guidelines aligned with contractual obligations and regulatory guidelines. They partner with Quality Improvement teams to analyze utilization trends and develop interventions to improve clinical effectiveness. Medical Directors, UM also serve as a key point of contact for physicians and providers, conducting peer-to-peer discussions to facilitate collaborative care and resolve issues. In addition, you will collaborate with Corporate Medical Directors, our Utilization and Case Management RNs and staff, and the Vice President, Medical Affairs.

Work Arrangement

Fully remote; must be willing to work rotational weekend and holidays.

Responsibilities

Ensures quality and clinically sound services for all enrollees through associates and providers.
Serves as medical advisor and manager for all clinically related activities
Ensures that the organization’s medical policies and procedures adhere to contractual obligations
Performs clinical case reviews in conjunction with the Medical Excellence Department.
Demonstrates knowledge of prescribed and established medical procedures and practices
Maintains familiarity with federal, state, and local medical and clinical operations regulations. Provides leadership in developing and implementing medical policy related to health management, compliance with applicable regulatory guidelines, AmeriHealth Caritas clinical policies and procedures, and contractual obligations
Manages day-to-day operations and monitors the integration and processing of members to optimize the appropriate use of behavioral and physical health services.
Participates with Quality Improvement and Medical Excellence in identifying and analyzing medical and behavioral health information to develop interventions to improve the clinical effectiveness of medical management strategies. Work closely with a multidisciplinary team to ensure behavioral health management and quality management programs meet contractual obligations
Works with the leadership of the Quality Improvement and Medical Excellence departments to develop competent clinical staff
Trains staff on medical issues and provides consultation to staff as appropriate
Assists Care Managers in assessing members’ needs for case management services and attends meetings and monthly rounds as scheduled
Collaborates with the integrated case management team during scheduled meetings and informally as needed
Thoroughly documents all care coordination activity in the member’s medical record in the electronic case management documentation system

Education and Experience

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required
Master of Health Administration (MHA), Master of Public Health (MPH), or Master of Business Administration (MBA) in Healthcare Management preferred
A minimum of three years of utilization management or appeals experience in a Medicaid, Medicare, and/or dual eligible
A minimum of five years of clinical practice experience required in family medicine, pediatrics, internal medicine, surgery, neonatology, or physiatry
Proficiency utilizing MS Office Suite, internet applications, and electronic medical record and documentation programs

Licensure

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) that is active and in good standing.
Must be able to obtain Pennsylvania license within 120 days of hire.
Additional medical licensure is required in all states where AmeriHealth Caritas has a line of business. The application is expected to be initiated within 30 days of hire.
Candidates must be board certified in their specialty. Must be clear of any sanctions by the applicable state or the Office of the Inspector General.
Must not be prohibited from participating in any Federally or state-funded healthcare programs.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Apply Now

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program manager jobs in redding, ca

Family Medicine Medical Director Utilization Management

Nurse Practitioner (Remote, Full-time)

Inpatient Medical Coding Quality Auditor

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