- Sevita (Artesia, CA)
- …individuals with functional disabilities of speech, language, voice, and swallowing. + Review medical records, test and evaluate individuals served and develop ... therapy treatment plans. + Identify and develop intervention strategies. + Instruct individuals we serve, family members, and primary caregivers to insure the maintenance of or to achieve the ideal functioning level for each person served. + Insure effective… more
- Sevita (Gilroy, CA)
- …individuals with functional disabilities of speech, language, voice, and swallowing. + Review medical records, test and evaluate individuals served and develop ... therapy treatment plans. + Identify and develop intervention strategies. + Instruct individuals we serve, family members, and primary caregivers to insure the maintenance of or to achieve the ideal functioning level for each person served. + Insure effective… more
- Insight Global (Los Angeles, CA)
- …guidelines for examiners to use in evaluating whether certain types of claims may require review and other medical claims issues. * Work with legal counsel on ... Job Description The Claims Review Coordinator is responsible for the investigation, documentation...Plan staff, Plan participants, business managers, health care providers, medical insurance companies and related governmental agencies, and … more
- Dignity Health (Rancho Cordova, CA)
- …planning activities, patient advocacy, clinical social work and best practice in medical necessity determination and concurrent review . This position will ... manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work interventions resulting in quality patient care. The… more
- CVS Health (Sacramento, CA)
- …performance metrics to identify areas to focus on and analyze results, including detailed review of medical cost drivers and DOS results. -Analyze premiums and ... will collaborate with constituent areas including Actuarial, Underwriting, Network and Medical Economics. -Resolve problems and drive issues to resolution. -Present… more
- Providence (CA)
- …Effectiveness and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and ... Utah **Required Qualification:** + Technical certification/licensure in the area of Medical Assistant, Certified Nurse Assistant, or Licensed Practical Nurse upon… more
- Dignity Health (Carmichael, CA)
- …risk reduction, patient experience, efficiency, FMEAS, and root cause analyses and medical staff improvement (eg peer review , OPPE, FPPE). Clinical performance ... regulatory performance improvement (PI) activities for the hospital and medical staff. This role also serves as a resource...improvement, including case review for peer review . + Participates in an integral role to ensure… more
- Cognizant (Sacramento, CA)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member… more
- AbbVie (Irvine, CA)
- …Development to identify educational opportunities and deficiencies + Management of our Medical , Legal, Regulatory, and Compliance review systems and processes, ... responsible for assisting in the development of curricula across Allergan Medical Institute educational programs, primarily large group programs across the Facial,… more
- Ventura County (Ventura, CA)
- …and Peer Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee for Quality Assurance ... Medical Director, Ventura County Health Care Plan Print...OPENING DATE: May 09, 2025 CLOSING DATE: Continuous FIRST REVIEW OF RESUMES: Week of May 26, 2025 Examples… more