- 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 ... of procedures for and the effective conduct of the system to review patients' medical charts to ascertain the medical necessity for services and… more
- Sharp HealthCare (San Diego, CA)
- …and outcomes studies as directed by the Quality Management + Committee, Peer Review Committee and Chief Medical Officer and reports findings in conjunction ... manner. + Able to manage difficult peer situations arising from medical care review . + Appreciation of cultural diversity and sensitivity towards target… more
- Sharp HealthCare (San Diego, CA)
- …improvement and outcomes studies as directed by the Quality Management Committee, Peer Review Committee and Chief Medical Officer and reports findings in ... manner. + Able to manage difficult peer situations arising from medical care review . + Appreciation of cultural diversity and sensitivity towards target… more
- Sumitomo Pharma (Sacramento, CA)
- …Initiated Study and Collaborative Research program. + Provide detailed and compliant medical review and approval of external resources, communications, and ... us on LinkedIn (https://c212.net/c/link/?t=0&l=en&o=4190475-1&h=2504638834&u=https%3A%2F%2Fwww.linkedin.com%2Fcompany%2Fsumitomo-pharma-america%2F&a=LinkedIn) . Job Overview The Director, Medical Strategy (Prostate Cancer) will be a key member… more
- Ascendis Pharma (Palo Alto, CA)
- …Liaises with Medical Monitors in Clinical Development to ensure that appropriate medical review and assessment is provided for adverse event reports and ... mission of developing new and potentially best-in-class therapies to address unmet medical needs. Our culture fosters a place where skilled, adaptable, and highly… 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. ... and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating in appropriate educational… more
- Centene Corporation (Sacramento, CA)
- …with quality, cost efficiency, and are within compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and ... quality of care issues, and if identified, refer to the Medical Director or provider for review and verification + Consults with senior management and healthcare… more
- AbbVie (San Francisco, CA)
- …and risk management plans. + Responsible for performing the accurate and detailed medical review of complex advertising and promotional materials for assigned ... medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's… 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 ... to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Humana (Sacramento, CA)
- …put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... rules, Humana policies and medical necessity. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex appeals for coverage… more