- LA Care Health Plan (Los Angeles, CA)
- …referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent ... Medical Director, on requests where determination requires extended review . Collaborates with the inpatient care team for facilitation/coordination of patient… more
- Humana (Sacramento, CA)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Veterans Affairs, Veterans Health Administration (Ukiah, CA)
- …store-and-forward) palpitation, auscultation, collecting vital signs. Incumbent performs retrospective medical review of non-VA health care records to ... and urgency. Refers complex cases to the CCRNs for more in-depth review . Analyzes submitted medical documentation to ensure all components necessary to aid in … more
- Veterans Affairs, Veterans Health Administration (Ukiah, CA)
- …Learn more Duties and responsibilities of the LVN/LPN include: Performs retrospective medical review of non-VA health care records to determine ... and urgency. Refers complex cases to the CCRNs for more in-depth review . Analyzes submitted medical documentation to ensure all components necessary to aid in … more
- Life Line Screening (Los Angeles, CA)
- …and bone density testing and front desk registration + Educate participants, review medical histories/risk factors, and make suggestions for medically ... Choose a Medical Assistant Career with CARE and earn a...$1,000 after 12 months of service! Are you a Medical Assistant, but a traveler at heart? Satisfy your… more
- Providence (CA)
- …Program:** + Communicate with patients, claimants, caregivers, providers, leadership + Review and analyze medical records, interview witnesses, assist with ... coverage + Set appropriate indemnity and expense reserves + Select appropriate medical experts for case review + Develop a plan of action for assigned claims and… more
- Cedars-Sinai (Beverly Hills, CA)
- …on the approved standard work. This position also assists with providing a review of Medical Assistant clinical and administrative skills, assessing the workflow ... **Job Description** **Join Cedars-Sinai!** **Cedars-Sinai Medical Center has been ranked the #1 hospital...ready to bring your clinical proficiencies to a world-class Medical Group known for the very highest clinical standards?… more
- US Military Entrance Processing Command (San Diego, CA)
- …required for physical examination. Perform phlebotomy procedures to obtain blood samples. Review unique medical forms for proper format, coding and completion. ... This will be filled on a permanent basis. Responsibilities Maintain applicant's medical records during the examination process. Manage medical consultations to… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …teams including providing oversight of integrated brand strategy and plans + Represents Global Medical Affairs on Copy Review governance committee + Is a core ... **Position Summary** : Reporting to the Vice President, Global Medical Affairs, the Executive Director, CNS Strategy, Global Medical Affairs is a leadership… more
- CVS Health (Sacramento, CA)
- … of fraud, waste, and abuse for individual Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for medical necessity review of ... disorders. + Make recommendation for enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health… more