- UCLA Health (Los Angeles, CA)
- …reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, ... UCLA Health protocols and national clinical guidelines (eg, InterQual, Milliman) in review decisions. + Coordinates escalations to medical directors and ensures… more
- Volunteers of America Los Angeles (Downey, CA)
- …SUMMARY AND PURPOSE While maintaining patient confidentiality and information security, the Biller, Medical will review , track and submit for review , patient ... Maintain SAGE files, generate reports as needed + Maintain medical billing supporting documentation + Monitor, review ...Maintain medical billing supporting documentation + Monitor, review and resubmit denied claims + In coordination with… more
- Evolent (Sacramento, CA)
- …with a focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates ... redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in… more
- Parexel (Sacramento, CA)
- …in high quality consultation on protocol development or drug development programs, medical review of various documents, collaboration on internal therapeutic ... Respect, Empowerment & Accountability. **Parexel is looking for a Medical Director with a very strong background in Ophthalmology...very strong background in Ophthalmology to join our Global Medical Sciences team.** **The role can be based remo**… more
- Dignity Health (Bakersfield, CA)
- …backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other ... offices primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and… 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
- CenterWell (Sacramento, CA)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid,… more
- Humana (Sacramento, CA)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Elevance Health (Costa Mesa, CA)
- **Clinical Operations Associate Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/Utilization Review ** **Virtual** : ... decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director ...attention, any case review decisions that require Medical Director review or policy interpretation. **Minimum… more
- Humana (Sacramento, CA)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more