109 Healthcare jobs in Rocklin

Position Summary:

The RT Vent Field Clinician is a Respiratory Therapist providing respiratory patient care to Vent patients for optimal outcomes. Provides respiratory care to patients in alternate sites in accordance with AdaptHealth's policies and procedures. Respiratory care will be preventative, rehabilitative, and palliative in nature. The RT will utilize all the resources available within the agency and community to accomplish care objectives. This position will provide education and care to the patient and communicate with team, physicians and referral sources and other patient agencies ensuring prompt attention to patient care issues.

Essential Functions and Job Responsibilities:

• Utilizes various sources of information to attain greater competence about his or her position, including attending educational events (including attending optional in-services) and asking questions.
• Utilizes acquired knowledge to increase his or her competencies.
• Consistently demonstrates ability to adequately complete all documentation and charting procedures in compliance with company policy and procedures.
• Maintains complete and accurate patient files by updating all documents per company policy and procedures.
• Reviews Plan of Treatments and Care Plans to assure they are accurate and up to date.
• Documents procedures including how the patient tolerated a procedure, side effects and other pertinent information.
• Assists with authorization for Ventilator referrals for patients.
• Shows adequate knowledge of respiratory equipment and displays ability to utilize knowledge in the clinical setting.
• Displays knowledge of assessment skills and demonstrates application of clinical skills during set-ups, follow-ups, and in-services.
• Participates in discharge planning of highly technical cases.
• Performs clinical assessments as needed and reports results and recommendations to the referral and physician.
• Participates in highly technical discharges and prepares in advance to assure the patient and caregivers have a smooth transition to the home setting.
• Performs in-services to hospital staff, referrals, other professionals regarding equipment & issues of clinical nature.
• Follows up with physician and referrals regarding patient status and documents accurately and in a timely manner.
• Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
• Works to promote AdaptHealth by new program development, operational backup, personal visits, coordination of educational activities, etc.
• Assume on-call responsibilities during non-business hours in accordance with company policy.
• Uses clinical expertise in evaluating vent patients records once a ventilator set up has been completed by the branch Respiratory Therapist.
• Ensures accuracy of prescriptions and plan of care was followed and documented. Also reviews delivery tickets, home inspection, ventilator check, and patient equipment competencies are complete and documented.
• Maintains proficient knowledge of ventilator patients including compliance software, new technology, units, and supplies supported by Adapthealth.
• Ability to demonstrate and instruct on use of vent units and supplies. Ability to make decisions for patients based on compliance data and assessment.
• Communicates with team, physicians and referral sources and other patient agencies ensuring prompt attention to patient care issues.
• Maintains working knowledge of Medicare/Medicaid and other third-party payer guidelines related to ventilation.
• Electronically documents patient care activity, intervention provided and all communication regarding the patient. Documentation is accurate, complete and follows company standards.
• Appropriate steps taken to ensure recommendations and orders sent are acknowledged and followed up in a timely manner.
• Responsible for accuracy, clarity, and timeliness of verbal and written communications as it relates to role.
• Responsible for documentation that supports data collection to track and trend outcomes.
• Assists in establishing clinical documentation when needed for third party reimbursement or justification.
• Uses knowledge in working with referral sources to educate about best practice standards.
• Works collaboratively and pro-actively with peers and other team members to resolve issues and assure optimum outcomes for patients, referral sources and staff.
• Acts as a resource on practices and processes to provide appropriate guidance.
• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth's Compliance Program.
• Perform other related duties as assigned during and outside of normal business hours as needed.

Competency, Skills, and Abilities:

• Experience with ventilator patients
• Competent in Ventilator, Airway Clearance, and Oxygen therapy administration and management
• Able to perform clinical assessments.
• Equipment troubleshooting and maintenance skills.
• Decision making skills.
• Expert communication and interpersonal skills
• Ability to prioritize tasks and manage multiple projects.
• Strong analytical and problem-solving skills with attention to detail
• Proficient use of Microsoft Office Suite – Excel, Word, and PowerPoint
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
• Knowledge of the regulatory requirements at the state, federal, and local level
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.

Education and Experience Requirements:

• Associates degree from an AMA approved respiratory program,
• Valid and unrestricted RT clinical license in all states serviced by the branch.
• Must be CPR certified,
• One (1) year of clinical experience as a Health Care RT, HME RT or clinical nursing with Vent experience.
• Valid and unrestricted driver's license

Physical Demands and Work Environment:

• Must be able to lift 50 pounds, stand, bend, stoop, and be able to sit at a computer for extended periods of time.
• Must be able to perform one-man CPR.
• Ability to perform repetitive movements of the upper extremities' motions of wrists, hands, and/or fingers due to extensive computer use.
• May be exposed to unsanitary conditions in some home settings.
• Work environment may be stressful at times, as overall office activities and work levels fluctuate.
• May be exposed to high crime areas within the service community.
• Subject to long periods of sitting and exposure to computer screen.
• May be exposed to hazardous materials, loud noise, extreme heat/cold, direct, or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogen.
• May be exposed to angry or irate customers or patients.
• Must be able to drive and travel as needed.
• Physical and mental ability to provide clinical assessments.
• Requires travel throughout service area.
• Mental ability to communicate both verbally and in writing.
• Must be able to access the patient's residence.
• Ability to work outside of normal business hours.
• Physical and mental ability to provide clinical assessments.

PI919ab1b50e7e-34600-37054871

Are you interested in making a meaningful impact in the health and safety of Californians?

The Healthcare Rights and Access Section leads proactive healthcare initiatives, representing the Attorney General in his independent capacity. The Tobacco Unit within the Healthcare Rights and Access Section works to protect California consumers and promote public health. It accomplishes this by implementing and defending the state's rights under the tobacco Master Settlement Agreement and by investigating and litigating cases related to both federal and state tobacco laws. Tobacco unit litigation is typically complex, often involving coordination across multiple states or agencies, the introduction of new products, evolving regulatory frameworks, and unique questions of contract and statutory interpretation.

Key responsibilities include, but are not limited to, investigating and litigating complex business actions from pre-filing discovery through trial and appeal. The team collaborates with local, state, and federal agencies, participates in coordinated investigations, negotiations, and settlements, and regulates and monitors industry compliance with statewide restrictions on flavored tobacco sales, as well as other federal and state tobacco laws.

While knowledge of tobacco enforcement laws is beneficial, it is not required to join our team. Please also refer to the Desirable Qualifications below.

Please let us know how you heard about our position by taking this brief survey:



You will find additional information about the job in the Duty Statement .

Working Conditions
This position may be eligible for telework. The amount of telework is at the discretion of the Department and based on DOJ's current telework policy. While DOJ supports telework, in-person attendance may be required based on operational needs. Employees are expected to be able to report to their worksite with minimal notification if an urgent need arises.

Minimum Requirements You will find the Minimum Requirements in the Class Specification.

• DEPUTY ATTORNEY GENERAL IV
• DEPUTY ATTORNEY GENERAL III

• Job Application Package Checklist
• Duty Statement

• This position is located in the Division of Public Rights, Healthcare Rights & Access Section, Tobacco Unit and may be filled in Sacramento or Oakland. Please list your preferred city in your cover letter.

• Please disregard the SROA/Surplus language below, as the Department of Justice requires applicants to submit their SROA/Surplus Letter if that is the basis of their eligibility.
  
  
• The Deputy Attorney General classifications qualify for a "Hire Above Minimum" (HAM) salary ( Hiring Above Minimum Policy ).
  
  The starting salary for each classification will be:
  • Deputy Attorney General III (5 years): 12,046
  • Deputy Attorney General IV (6+ years): 13,313
  New to State candidates in the DAG series will be hired at the starting HAM salary of the classifications.
  
  

• For more information about the department please visit the Attorney General's website at .

• If you'd like to speak with a recruiter prior to submitting your application, please email

• A fingerprint check will be required.

• Clearly indicate the Job Control Code (JC-486948), and the title of this position in the "Examination or Job Title(s) For Which You Are Applying" section located on the first page of your State Application.

• Individuals who are new to state service must have list eligibility in order to gain employment with the California Office of the Attorney General. The process is described at

• Please note that appointment to the DAG classifications will be made using the following examinations:
  • DAG III exam- at least 5 years of legal experience: DAG III Examination
  • DAG IV exam- at least 6 years of legal experience: DAG IV Examination

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is required and must be included.
• Other - A cover letter is required and must be submitted.
• Other - Writing Sample, consisting of a dispositive motion, pretrial motion, or appellate brief is required.

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

*COMPENSATION AND BENEFITS WILL BE DETERMINED BASED UPON FAIR MARKET VALUE ANALYSIS.

Provides Clinical Informatics leadership with focus on Pediatrics to maximize the health of patients we serve at Sutter Health through the adoption, use, and optimization of digital technologies.

Collaborates and partners with senior leadership, other departments, clinical service lines, and clinicians across the system across all clinical settings.

As a physician informatics leader, supports enterprise strategic objectives using digital technologies. Partners with appropriate clinical representatives to optimize clinical content and physician workflows, usability, adoption, and training for digital systems including the electronic health record (EHR).

Job Description :

EDUCATION:

• Doctorate: MD or DO

CERTIFICATION & LICENSURE:

• MD-Doctor of Medicine Upon Hire

• OR DO-Doctor of Osteopathy of California

• Board Certification in Pediatrics

• EPIC-EPIC Certification within 180 Days of hire

TYPICAL EXPERIENCE:

• 8 years recent relevant experience

SKILLS AND KNOWLEDGE :

• Clinical practice experience and a strong background in health information technology.

• Leadership and management experience within a complex multi-site matric managed healthcare environment.

• Understanding of and proven experience in utilizing EHR technology to positively transform clinical practice by improving the quality of patient care, reducing costs and driving user satisfaction across the care continuum.

• Working knowledge of the clinical care information systems implementation process, integration of workflows, use and support methodologies, regulatory requirements, strategic and tactical planning, project leadership/management and group dynamics.

• Strong working knowledge of the Epic healthcare software.

• Solid expertise in organizational change management concepts and strategies, including proactively using that body of knowledge to constructively transform the clinician and patient experience across the continuum of care.

• Demonstrated knowledge regarding potential impact of Stark, privacy and security laws and regulations on implementation and ongoing use of health IT systems.

• Understanding of and experience with process improvement philosophies and methodologies.

• Solid expertise in selection, development and implementation of a broad range of clinical care information systems as well as process redesign and significant quality improvements.

• Significant experience developing and leading electronic health record (EHR) training and support initiatives in a clinical care setting.

• Demonstrated ability to bridge the gap between patients, healthcare practitioners, enterprise leadership, and computer/data processing specialists, while maintaining and securing all patient records.

• Recognized ability to energize, mobilize, influence, and build accountability with a broad range of stakeholders through effective communication of vision, and the fostering of productive and supportive working relationships with internal and external constituencies.

• Superior negotiating and problem-solving skills with the proven ability to identify, research and analyze issues to offer effective solutions.

• Written and verbal communication skills, including the ability to translate business needs into application and operational requirements, as well as lay terms

• Advanced level of computer competency in Microsoft Office Suite, including EHR/computerized physician order entry (CPOE) applications, as well as other relevant software for research and analysis

Job Shift:

Days

Schedule:

Varied

Days of the Week:

Monday - Friday

Weekend Requirements:

As Needed

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

20

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $1.00 to $00.00 / hour. Based upon Fair Market Value analysis Pay Range is 1.00 to 500.00 / hour.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

*COMPENSATION AND BENEFITS WILL BE DETERMINED BASED UPON FAIR MARKET VALUE ANALYSIS.

Provides Clinical Informatics leadership with focus on Oncology to maximize the health of patients we serve at Sutter Health through the adoption, use, and optimization of digital technologies.

Collaborates and partners with senior leadership, other departments, clinical service lines, and clinicians across the system across.

As a physician informatics leader, supports enterprise strategic objectives using digital technologies. Partners with appropriate clinical representatives to optimize clinical content and physician workflows, usability, adoption, and training for digital systems including the electronic health record (EHR).

Job Description :

EDUCATION:

• Doctorate: MD or DO

CERTIFICATION & LICENSURE:

• MD-Doctor of Medicine Upon Hire

• OR DO-Doctor of Osteopathy of California

• Board Certification in Medical Oncology

• EPIC-EPIC Certification within 180 Days of hire

TYPICAL EXPERIENCE:

• 8 years recent relevant experience

SKILLS AND KNOWLEDGE :

• Clinical practice experience and a strong background in health information technology.

• Leadership and management experience within a complex multi-site matric managed healthcare environment.

• Understanding of and proven experience in utilizing EHR technology to positively transform clinical practice by improving the quality of patient care, reducing costs and driving user satisfaction across the care continuum.

• Working knowledge of the clinical care information systems implementation process, integration of workflows, use and support methodologies, regulatory requirements, strategic and tactical planning, project leadership/management and group dynamics.

• Strong working knowledge of the Epic healthcare software.

• Solid expertise in organizational change management concepts and strategies, including proactively using that body of knowledge to constructively transform the clinician and patient experience across the continuum of care.

• Demonstrated knowledge regarding potential impact of Stark, privacy and security laws and regulations on implementation and ongoing use of health IT systems.

• Understanding of and experience with process improvement philosophies and methodologies.

• Solid expertise in selection, development and implementation of a broad range of clinical care information systems as well as process redesign and significant quality improvements.

• Significant experience developing and leading electronic health record (EHR) training and support initiatives in a clinical care setting.

• Demonstrated ability to bridge the gap between patients, healthcare practitioners, enterprise leadership, and computer/data processing specialists, while maintaining and securing all patient records.

• Recognized ability to energize, mobilize, influence, and build accountability with a broad range of stakeholders through effective communication of vision, and the fostering of productive and supportive working relationships with internal and external constituencies.

• Superior negotiating and problem-solving skills with the proven ability to identify, research and analyze issues to offer effective solutions.

• Written and verbal communication skills, including the ability to translate business needs into application and operational requirements, as well as lay terms

• Advanced level of computer competency in Microsoft Office Suite, including EHR/computerized physician order entry (CPOE) applications, as well as other relevant software for research and analysis

Job Shift:

Days

Schedule:

Varied

Days of the Week:

Monday - Friday

Weekend Requirements:

As Needed

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

20

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $1.00 to $00.00 / hour. Based upon Fair Market Value analysis Pay Range is 1.00 to 500.00 / hour.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Minimum 5 years direct patient behavioral health clinical care experience post residency required
• Medical degree (M.D./D.O.)
• Completed residency in Psychiatry
• Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
• Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required

Preferred Qualifications:

• Recent inpatient psychiatric hospital experience (within the past five years)
• Recent substance use disorders treatment experience (within the past five years)
• Well-versed with most areas of behavioral health services and conditions
• Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
• Experience with CPT coding, medical claims review, hospital billing, and reimbursement
• Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
• Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health
• Experience with ASAM, LOCUS, CALOCUS, and WPATH

Become a part of our caring community and help us put health first

The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Candidate must have valid Florida Medical license and must be able to start with 30-60 days of hire.

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.

The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activites.

Use your skills to make an impact

Responsibilities

The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Candidates must be able to start with 30-60 days of hire.

Required Qualifications

• MD or DO degree

• Valid Florida Medical license

• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

• Current and ongoing Board Certification an approved ABMS Medical Specialty

• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.

• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

• Excellent verbal and written communication skills .

• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.

Preferred Qualifications

• Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists with recent inpatient experience preferred

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

• Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

• Experience with national guidelines such as MCG® or InterQual

• Advanced degree such as an MBA, MHA, MPH

• Exposure to Public Health, Population Health, analytics, and use of business metrics.

• Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

• The curiosity to learn, the flexibility to adapt and the courage to innovate

Additional Information

Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.

#physiciancareers

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$223,800 - $313,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 08-31-2025

About us

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

Hospitals on Incredible Health are actively hiring and accepting applications in the Sacramento, CA area for the following position: Nurse Manager - Intensive Care Unit. Nurses with experience in any of the following areas are strongly encouraged to apply: Arrhythmia management, Assistant Nurse Manager, Bariatric, CNO, CODE, COVID, CRRT training, CVICU, Care of burn patients, Charge, Chest tube, Clinical Nurse Coordinator, Director, ECMO, External pacemaker, High acuity, Intra aortic balloon pump, MICU, Manager, Neuro ICU, Post MI thermo care , Post cardiac surgery care, Post neuro surgery, RRT, SICU, Supervisor, TPA admin, Transplant, VP, or Vascular intervention. Shift(s) available: day shift Job types available: full time, part time, and per diem Employer features: Best Places to Work recognition, Cross training, EAP, Medical, Retirement Plan, U.S. News best hospital Qualifications: BS/BSN degree or higher from an accredited school of nursing Active and unencumbered Registered Nurse license in the state of California Benefits: Healthcare coverage: Medical, Dental, Vision 401K Paid Time Off Tuition Assistance Salary: $115,000 to $145,000 /year

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Minimum 5 years direct patient behavioral health clinical care experience post residency required
• Medical degree (M.D./D.O.)
• Completed residency in Psychiatry
• Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
• Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required

Preferred Qualifications:

• Recent inpatient psychiatric hospital experience (within the past five years)
• Recent substance use disorders treatment experience (within the past five years)
• Well-versed with most areas of behavioral health services and conditions
• Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
• Experience with CPT coding, medical claims review, hospital billing, and reimbursement
• Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
• Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health
• Experience with ASAM, LOCUS, CALOCUS, and WPATH

Become a part of our caring community and help us put health first

The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.

The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activites.

Use your skills to make an impact

Responsibilities

The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) and community relations as directed.

Required Qualifications

• MD or DO degree

• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

• Current and ongoing Board Certification an approved ABMS Medical Specialty

• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.

• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

• Excellent verbal and written communication skills.

• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

• Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

• Experience with national guidelines such as MCG® or InterQual

• Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists

• Advanced degree such as an MBA, MHA, MPH

• Exposure to Public Health, Population Health, analytics, and use of business metrics.

• Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

• The curiosity to learn, the flexibility to adapt and the courage to innovate

Additional Information

Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.

#physiciancareers

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$223,800 - $313,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 08-10-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our