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Director of Operations
5 days ago
Cheer Home Care, LLC. California, United States: · Are you looking for a position that allows you to make a difference in the lives of the aging population? · Are you looking for a company that cares about your well-being and professional growth? Then you found us. Please join Cheer Home Care and help us bring some cheer to ...
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Director of Operations
5 days ago
Caldera Medical California, United StatesDirector of Operations · Caldera Medical's Mission - To Improve the Quality of Life for Women · Caldera Medical is · actively seeking a Director of Operations to support Caldera Medical's rapid growth. This role is a critical member of the management team. · Qualifications: · 1 ...
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Director, Operations
1 day ago
Fdhaero California, United StatesIf you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. · Director, Operations · Full Time · Commerce, CA, US · FDH · is a leading global distributor of aerospace parts and mat ...
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Cluster Director of Operations
1 day ago
Italian Hospitality Collection California, United StatesItalian Hospitality Collection · | Permanent · Cluster Director of Operations · We are recruitingfor a · Cluster Director of Operations · for Chia Laguna Resort, which iscomposed of three hotels: · Conrad Chia Laguna Sardinia · , · Baia di Chia Resort Sardinia Curio Collec ...
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Director Project Operations
2 days ago
Park Lane Recruitment Ltd California, United StatesDirector Project Operations · California · USA · Job Type: · Full Time/Direct Hire · Remote Status · : No Remote · Relocation Paid : · No · Industry(ies) · : Food & Beverage Products/ Services, Logistics / Distribution / Wholesale · Primary Skills · : Process Automatio ...
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HR Operations Director
2 days ago
Crypto California, United StatesOur HR team oversees and contributes at both hands-on and strategic levels to support leaders and our employees. While HR, at its core, focuses on the mindful management of the company's relationship with our employees, culture management focuses on the heartfelt aspects of the e ...
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Aspcapro California, United StatesPlease make sure to attach your resume to complete your application. · Summary: · Who we are: · Have you ever wondered what happens to cats and dogs whose owners are unable to afford veterinary care? We did. The ASPCA's Community Medicine (CM) team provides expert veterinary care ...
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Director of Operations
6 days ago
Watlow Columbia, United StatesWorking at Watlow · Are you looking for an opportunity to make a great living and be part of a thriving cross functional community? Watlow is a global technology and manufacturing leader who provides world class engineering expertise through innovative thermal products and syste ...
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Director of Operations
5 days ago
CTI - Gas Detection Specialists Columbia, United StatesThe Operations Director has operational responsibility for the management of manufacturing facilities, including contract manufacturing partners. This position is accountable to meet all business goals related to operations, including operational efficiency, cost targets, Environ ...
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Director of Operations
5 days ago
Watlow Columbia, United StatesAs the Director of Operations for the Watlow Manufacturing Center of Excellence in Columbia, Missouri your role is crucial in overseeing the efficient and effective functioning of all manufacturing operations for the site. The Director of Operations is a key member of the Operati ...
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Director of Operations
3 days ago
Watlow Columbia, United StatesWorking at Watlow · Are you looking for an opportunity to make a great living and be part of a thriving cross functional community? Watlow is a global technology and manufacturing leader who provides world class engineering expertise through innovative thermal products and syste ...
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Director of Operations
2 days ago
University of MissouriColumbia Columbia, United StatesHiring Department · Intercollegiate Athletics · Job Description · Reporting to the Head Coach, the Director of Operations will monitor and serve as a liaison with the athletics compliance office on all NCAA and Conference rules and guidelines as they pertain to the recruitment ...
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Director of Operations
6 days ago
Watlow Columbia, United StatesWorking at Watlow · Are you looking for an opportunity to make a great living and be part of a thriving cross functional community? Watlow is a global technology and manufacturing leader who provides world class engineering expertise through innovative thermal products and syste ...
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regional operations director
1 day ago
Americare Senior Living Columbia, MO, United StatesPosition Details · * Education: College · * Employment Status: Full-Time · * Is Remote?: No · * Salary: Annually · Are you looking to have fun while making a difference in someone's life? · Who We Are · At Americare we make a difference in the everyday lives of others and we are ...
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Dance Studio Operations Director
1 day ago
Releve' Dance Company Clarence, United StatesJob Description · Job DescriptionGrowing Dance Studio is looking for a Dance Studio Operations Director to become an integral part of our team · You will coordinate and oversee the organization's daily operations, provide structured policies and guidence geared toward improving ...
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Assistant for Operations and R&D Director
3 days ago
IMKO Jefferson City, United StatesJob Description · Job DescriptionIMKO Workforce Solutions is looking for an Assistant for Operations and R&D Director for a local culvert company in Columbia, MO. The ideal candidate will need to be able to manage the existing and future plants operations and growth and to work o ...
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Centene Corporation Jefferson City, United StatesYou could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, youll have access to competitive benefits including a fresh perspective on workplace flexi ...
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Assistant Parks and Recreation Director
1 day ago
Parksandrecipes California, United StatesAssistant Parks and Recreation Director in the City of Brentwood, CA · Salary range :$144,125 - $175,185 · Summary of duties : Plan, direct, and evaluate the programs and services of the Parks and Recreation Department including construction, development, maintenance and repair ...
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Kering SA California, United StatesBOTTEGA VENETA Assistant Store Director, Beverly Hills Flagship page is loaded · BOTTEGA VENETA Assistant Store Director, Beverly Hills Flagship · Apply · locations · BEVERLY HILLS · time type · Full time · posted on · Posted Yesterday · job requisition id · R128675 · ...
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Director of Global Advocacy and Policy
2 days ago
Pailin Group Psc California, United Statespeople-oriented, has good listening skills, is creative and able to think out of the box · The Director of Global Advocacy and Policy contributes to the organization's mission by demonstrating passion in improving HIV policies around the world. The Director is a well experienced ...
Medical Director, Operations - California, United States - Blue Shield
Description
Your RoleThe 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.Your Work
In this role, you will:
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.
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 competencyThe 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
Work independently to achieve objectives and resolve issues in ambiguous circumstances
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
Work in high-pressure situations while maintaining good leadership and reasoning ability
Demonstrate strong collaboration skills to effectively work as a team that consist of MDs, RNs, patient care coordinators, and case/disease managers
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; strong interpersonal and communication skills are needed to effectively interact with employees and clients in a professional and tactful manner
Lead and provide training and guidance to others
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