- Molina Healthcare (Sacramento, CA)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Prime Healthcare (Encino, CA)
- …dedicated professionals committed to our core values of quality , compassion and community! Why Prime Healthcare? ... and reporting of patient test results, 2) follow the laboratory's established quality control policies and procedures in documenting all corrective actions taken… more
- Ventura County (Ventura, CA)
- …as needed for outside services for patients/families; + Conducts daily clinical reviews for utilization/ quality management activities based on ... scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation of patient… more
- Ventura County (Ventura, CA)
- …credentialing and Re-Credentialing. Develops practice profile indicators. Member of Credentialing, Quality Assurance (QA) and Peer Review Committees. Presents to ... and treatment + Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs… more
- Evolent (Sacramento, CA)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as… more
- Evolent (Sacramento, CA)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. . Aids and acts as… more
- Evolent (Sacramento, CA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with… more
- Dignity Health (Bakersfield, CA)
- …health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups ... for ensuring the integrity of the adverse determination processes and accuracy of clinical decision making, as it relates to the application of criteria and… more
- Elevance Health (CA)
- …is received. May be responsible for developing and implementing programs to improve quality , cost, and outcomes. May provide clinical consultation and serve as ... changes in healthcare. + Leads, develops, directs, and implements clinical and non- clinical activities that impact health care quality cost and outcomes. +… more
- Abbott (Sylmar, CA)
- …Develop and mentor regulatory professionals **Premarket:** + Assess the acceptability of quality , preclinical and clinical documentation for submission filing + ... Mission: why we exist Our business purpose is to restore health and improve quality of life through the design and provision of device and Cardiac Rythm Management… more