- BeOne Medicines (Emeryville, CA)
- …currently have an exciting opportunity available for an experienced Senior Director , Investigator-Initiated Trials (IIT) and Expanded Access Programs in Global ... EAPs, Phase IV studies and create the structure for review of post-hoc analysis requests. This is a Remote-based...with key initiatives and strategies to support the global utilization of related BeiOne products. + Lead the IIT,… 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 SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Sevita (Chico, CA)
- …all every day. Join us today, and experience a career well lived. **Regional Director ** **Annual Salary: $93,000** Have you been looking for a fantastic role to ... quality. + Execute regional core growth strategy to increase census, maximize utilization and occupancy percentages; respond to local requests for proposals to… more
- Abbott (Alameda, CA)
- …to manage their disease-state and live life to the fullest. As the IT Director Business Relationship Management - Global Data Analytics, you will play a pivotal role ... accountability across business domains to support ethical and effective data utilization . **Demand/Intake Management** + Build deep relationships with our business… more
- Travelers Insurance Company (Sacramento, CA)
- …which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical ... guidelines to establish medical review policies. Works in close collaboration with the Claim...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more
- Centene Corporation (Sacramento, CA)
- …to identify quality of care issues, and if identified, refer to the Medical Director or provider for review and verification + Consults with senior management ... California RN Licensing Highly Preferred **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …degree preferred. + Experience: A minimum of two years of clinical experience in Utilization Review or Case Management is preferred. + Per Diem Positions: Case ... and hospital information systems required. Must demonstrate knowledge of current utilization management principles, third party payor review requirements,… more
- CenterWell (San Diego, CA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- HCA Healthcare (Riverside, CA)
- …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more