- Humana (Sacramento, CA)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... societies + Please note this role will consist of working mostly independently to review at times large amount of clinical information to update clinical… more
- Highmark Health (Sacramento, CA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or… more
- Gilead Sciences, Inc. (Santa Monica, CA)
- …help create more tomorrows. **Job Description** + The **Senior Manager, Planisware Clinical Trial Planning, Resource Management, and Reporting** is a member of the ... and Business Operations team within Development.The role is accountable for ** clinical trial planning activities using Planisware** 1.) accuracy of the critical… more
- Cedars-Sinai (Los Angeles, CA)
- …+ Identifies patients eligible for the value-based program, provides direct and indirect clinical care services to selected patients within the licensed scope of ... + Maintains close coordination between the home department and Clinical Efficiency & Value team to review ...the use of value-based principles in all aspects of clinical care across the organization and teaches… more
- Stanford University (Stanford, CA)
- …and regulatory or governing bodies, which include HIPAA and FDA regulations, Institutional Review Board requirements, and Good Clinical Practices. + Knowledge of ... Clinical Research Coordinator 2 (6 Month Fixed-Term) (Hybrid...research program in theDivision of Pulmonary, Allergy, and Critical Care Medicine (PACCM). This is an opportunity to work… more
- Dignity Health (Rancho Cordova, CA)
- …years Utilization experience required in health plan/UM operations, Acute or subacute utilization review . - Graduate of an accredited school of nursing. - BS ... that provides a clinical and financial approach through the continuum of care . Promotes the quality and cost effectiveness of medical care by ensuring… more
- Fresenius Medical Center (Moreno Valley, CA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care , you will ensure that quality patient care is delivered while maintaining clinical ... will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal… more
- Fresenius Medical Center (Rancho Cucamonga, CA)
- …of their clinical and operational processes to impact patient centered care resulting in improved patient outcomes and satisfaction and decreased morbidity and ... Advisory Board Recommended Algorithms and Standing Orders, clinical pathways and clinical policies and procedures to improve care coordination and care… more
- Prime Healthcare (Garden Grove, CA)
- …communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Works with health information ... staff, coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission...Management experience is highly preferred. 3. 1+ year of clinical experience in acute care setting preferred.… more
- Dignity Health (Folsom, CA)
- …of pharmaceutical care distribution systems + Knowledge of drug utilization review , quality improvement techniques, pharmacy automation + Understanding of ... add to their hospital staff. The incumbent is responsible for providing clinical pharmacy services including the implementation of both system and facility Pharmacy… more