- CVS Health (Sacramento, CA)
- …skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and ... 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and unrestricted RN license… more
- CVS Health (Sacramento, CA)
- …for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on ... rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity ... indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and… more
- BeOne Medicines (Emeryville, CA)
- …data & drafts response and manages approval of responses + Guides and leads medical review of SAEs and provides immediate input to escalated reports, determines ... input to CRFs + Leads the formulation safety criteria and review of study specific medical monitoring plans + Participates in investigator meetings, as needed,… 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 plan ... and safety. In this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing...Travel to various clinic sites and schedule and conduct medical record and facility site audits + Conduct thorough… more
- Travelers Insurance Company (Sacramento, CA)
- …influences 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 leaders and in partnership with other … more
- Sedgwick (Sacramento, CA)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...+ Member of a client Disability Pension Board + Review of identified appeal cases for quality assurance purposes… more
- Centene Corporation (Sacramento, CA)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- Sumitomo Pharma (Sacramento, CA)
- …including pre- and post-marketing US FDA and/or EU ICH safety requirements** + Expertise in medical review of medical review of Individual case safety ... dynamic, highly motivated, and experienced individual for the position of **Associate Medical Director.** The Associate Medical Director will provide hands-on… more
- The County of Los Angeles (Los Angeles, CA)
- …staff training is needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to ... OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II: Two (2) years of… more
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