- The County of Los Angeles (Los Angeles, CA)
- …for medical care evaluation studies. + Works with Professional Standards Review Organization representative to orient new staff to Federal laws and regulations ... UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply ...of community partner clinics - DHS annually provides direct care for 600,000 unique patients, employs over 23,000 staff,… more
- Sevita (Santa Barbara, CA)
- …day. Join us today, and experience a career well lived. **Program Services Clinical Coordinator** Everybody needs a job but only extraordinary people work here. Our ... the lives of the people we serve. + Coordinate the development, review , and implementation of services, case management, behavior intervention plans, and treatments… more
- Veterans Affairs, Veterans Health Administration (Santa Rosa, CA)
- …resolved. Functions or Scopes of Practice: The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, ... Applying administrative judgment, the use of wide range of clinical flow processes relating to access to care... clinical flow processes relating to access to care across multiple clinical , specialties. Recommends changes… more
- Elevance Health (Walnut Creek, CA)
- …and patients' office visits with providers and external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres ... + As assigned, engage in clinical and non- clinical activities that impact health care quality...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
- Evolent (Sacramento, CA)
- …operations, ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review . + Ensure compliance and quality for all coding ... requirements. + Develop and provide ongoing training and support to health care providers on clinical documentation requirements, risk adjustment coding… more
- Prime Healthcare (Lynwood, CA)
- …our community who count on the hospital for high quality and compassionate medical care . St. Francis is recognized for its full range of diagnostic and treatment ... Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care . In addition, the hospital offers a broad array of education… more
- Sharp HealthCare (San Diego, CA)
- …decisive manner. + Able to manage difficult peer situations arising from medical care review . + Appreciation of cultural diversity and sensitivity towards target ... regard to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances. Collaborates with Customer Care Manager to… more
- Emanate Health (Covina, CA)
- …and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and ... utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for … more
- Dignity Health (Santa Cruz, CA)
- … Clinical Pharmacist, or other Licensed Clinical Staff and three (3) years clinical experience in an acute care setting + Must be able to perform case ... The primary function of the Quality/Patient Safety Program Manager Clinical License is to support, coordinate, and facilitate the...root cause analyses and medical staff improvement (eg case review for peer review , OPPE, FPPE). +… more
- Dignity Health (Stockton, CA)
- …therapy to patients by assessing nutritional status, developing a plan of care to maintain or improve nutritional status, periodically evaluating the patient's ... response to the plan of care , and modifying it as required for optimal outcomes....dietitian is expected to maintain professional development via: peer review of neonatal and pediatric nutrition assessments and/or follow-ups… more
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