- Elevance Health (Los Angeles, CA)
- …care management or case management experience and requires a minimum of 2 years clinical , utilization review , or managed care experience; or any combination of ... Rotating Weekends and holidays. The **Medical Management Nurse** is responsible for review of the most complex or challenging cases that require nursing judgment,… more
- Humana (Sacramento, CA)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- Humana (Sacramento, CA)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference… more
- Swedish Health Services (CA)
- …timely and accurate preparation and maintenance of budget templates for sponsored clinical trials, including the comparative review against budgets offered by ... **Description** **Remote Position** The Clinical Research Budgets Analyst will be responsible for...Main responsibilities include, but are not limited to, the review of New Study routing forms and essential study… more
- Humana (Sacramento, CA)
- …team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical … more
- Sutter Health (Mountain View, CA)
- …a collaborative practice agreement or an approved protocol. + Completes medication regimen review from a clinical , safety and cost perspective to identify ... Overview:** Delivers pharmaceutical care through the provision of patient-centered clinical service, medication information, education, medication preparation and distribution… more
- UCLA Health (Los Angeles, CA)
- …documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established ... necessity and benefit coverage. + Applies UCLA Health protocols and national clinical guidelines (eg, InterQual, Milliman) in review decisions. + Coordinates… more
- CVS Health (Sacramento, CA)
- …of this Medical Director role include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits ... Policy & Operations) you will be responsible for providing clinical expertise and business direction in support of medical... and coding policy and experience with appeals, claim review , reimbursement issues, and coding is preferable, but a… more
- Edwards Lifesciences (Irvine, CA)
- …+ Experience with maintaining current, in-depth product knowledge including current developments, clinical literature review , as well as therapeutic and product ... your ideas and expertise can change a patient's life. We generate extensive clinical evidence to demonstrate the effectiveness and safety of our innovations and how… more
- HCA Healthcare (Los Gatos, CA)
- …in your career path, we encourage you to apply for our PreOp PACU Clinical Nurse Coordinator opening. We review all applications. Qualified candidates will be ... you have the career opportunities as a PreOp PACU Clinical Nurse Coordinator you want in your current role?...at Los Gatos Surgical! **Job Summary and Qualifications** The Clinical Nurse Coordinator (CNC) ensures and delivers high quality,… more