- Elevance Health (Los Angeles, CA)
- …and external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres to medical policies and clinical guidelines. ... **Behavioral Health Medical Director- Child Psychiatrist** Location: This role enables...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
- Travelers Insurance Company (Diamond Bar, CA)
- …Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as ... regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. + Investigate, develop, and evaluate action… more
- Travelers Insurance Company (Diamond Bar, CA)
- …such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of ... evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality standards and… more
- Stryker (San Jose, CA)
- …will be considered. Actual compensation may vary. \#LI-REMOTE Health benefits include: Medical and prescription drug insurance , dental insurance , vision ... Gain commitment from specific groups to do economic analysis and clinical performance review . + Use economic analysis and clinical performance review information… more
- CRC Insurance Services, Inc. (Woodland Hills, CA)
- …by the division of CRC Group offering the position. CRC Group offers medical , dental, vision, life insurance , disability, accidental death and dismemberment, ... (Required) **Work Shift:** 1st Shift (United States of America) **Please review the following job description:** We are seeking a high-performing, self-motivated… 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 ... setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in...MD review process to reflect appropriate utilization and compliance with… 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 ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...MD review process to reflect appropriate utilization and compliance with… more
- Elevance Health (CA)
- …and Experiences:** + Utilization Management experience is strongly preferred. + Health insurance billing and/or medical coding experience is strongly preferred. ... ** Medical Management Clinician Senior** **Location:** This role enables...scope of licensure. + These reviews may require in-depth review ; however, any deviation from application of benefits plans… more
- Evolent (Sacramento, CA)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Sacramento, CA)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially...MD review process to reflect appropriate utilization and compliance with… more