- CVS Health (Sacramento, CA)
- …legal, compliance, or rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates ... in determining correct coding and appropriate documentation during the review of medical records . This...+ A minimum of 5 years of experience in medical record review for coding… more
- Emanate Health (Covina, CA)
- …United States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and… more
- UCLA Health (Los Angeles, CA)
- …including inspections of clinical areas, patient care practices, and administrative processes + Review medical records of services in preparation for health ... include: + Travel to various clinic sites and schedule and conduct medical record and facility site audits + Conduct thorough facility site reviews and… more
- The County of Los Angeles (Los Angeles, CA)
- …direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of ... for and the effective conduct of the system to review patients' medical charts to ascertain the...SECURITY NUMBER: Please include your Social Security Number for record control purposes. Federal law requires that all employed… more
- Centene Corporation (Sacramento, CA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. +...by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA… more
- The County of Los Angeles (Los Angeles, CA)
- …authorization for the issuance of denial letters. + Reviews, retrospectively, utilization review records for completeness, use of appropriate codes, correctness ... physician advisor for follow up on referrals. + Reviews, retrospectively, Utilization Review Records for completeness, use of appropriate codes, correctness of… more
- Sumitomo Pharma (Sacramento, CA)
- …Initiated Study and Collaborative Research program. + Provide detailed and compliant medical review and approval of external resources, communications, and ... as appropriate. + Capable of translating brand goals and objectives into actionable medical and scientific strategies. + Proven track record of detailed,… more
- Centene Corporation (Sacramento, CA)
- …compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and clinical research criteria to determine if ... at the most efficient and effective level + Reviews medical records for medical necessity...of care issues, and if identified, refer to the Medical Director or provider for review and… more
- Alameda Health System (Oakland, CA)
- …outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical necessity criteria. ... system. 9. Conduct concurrent and admission reviews of patient records to assess medical necessity and adherence...changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care)… more
- Humana (Sacramento, CA)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... health topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of moderately complex… more
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