- The County of Los Angeles (Los Angeles, CA)
- …pertaining to Medicare and Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued stay is being ... criteria and standards; serves as the liaison with the physician advisor for the referral of unusual...so may result in an incomplete application and may lead to disqualification. We will send notifications to the… more
- Sutter Health (Los Altos, CA)
- …Strategy has overall responsibility for growth, delivery system and physician development initiatives related directly to growth-oriented strategic initiatives, ... service line strategic planning and business development, physician network development and strategy, and strategic partnerships within the Sutter Health Silicon… more
- Sedgwick (West Hills, CA)
- …external support and arranges referrals to vendors for services such as physician advisor reviews, surveillance, independent medical evaluations, and functional ... on received documentation or recommends denial to the team lead in alignment with the disability plan.** **Carefully reviews...physician and employer.** **Escalates cases to the team lead or clinical case management for further review when… more
- Sedgwick (West Hills, CA)
- …and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability ... complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan....physician and employer. + Refers cases to team lead and clinical case management for additional review when… more
- CommonSpirit Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** **Location - This position will support the Physician Enterprise in the National office so you can reside anywhere in the ... Delivery Consulting, this role serves as a strategic partner and trusted advisor to regional and market leaders. The consultant will design, implement, and… more
- Sharp HealthCare (San Diego, CA)
- …utilization management venues.Escalate and refers cases for consultation with Physician Advisor or Medical Director as appropriate.Oversee preparation, ... a comprehensive plan of care for each patient/family in collaboration with the physician , social worker and all members of the interdisciplinary team in the… more
- Sedgwick (West Hills, CA)
- …and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability ... routine disability claims or makes a recommendation to team lead to deny claims based on the disability plan....work with or without job accommodations via the claimant's physician and employer. + Refers cases as appropriate to… more
- Providence (Irvine, CA)
- …of contract performance issues. + Payor Dispute and Litigation Support: + Lead or support payor disputes involving underpayment, nonpayment, recoupments, audits, and ... delivery models. + Advise on regulatory and contractual issues affecting physician groups, clinically integrated networks, and value-based arrangements. + Regulatory… more
- Sharp HealthCare (La Mesa, CA)
- …utilization management venues.Escalate and refers cases for consultation with Physician Advisor or Medical Director as appropriate.Oversee preparation, ... a comprehensive plan of care for each patient/family in collaboration with the physician , social worker and all members of the interdisciplinary team in the… more
- Sharp HealthCare (San Diego, CA)
- …utilization management venues.Escalate and refers cases for consultation with Physician Advisor or Medical Director as appropriate.Oversee preparation, ... a comprehensive plan of care for each patient/family in collaboration with the physician , social worker and all members of the interdisciplinary team in the… more