- Sutter Health (Sacramento, CA)
- …expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices, level ... physician Advisor will work closely with the medical staff, including house staff, and all utilization...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... Medi-Cal reimbursement. + Analyzes cases for referral to the physician advisor to ensure that the admission or continued...I:One year of experience performing the duties of a Utilization Review Nurse* or Medical … more
- The County of Los Angeles (Los Angeles, CA)
- …administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the ... Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician...for and the effective conduct of the system to review patients' medical charts to ascertain the… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- LA Care Health Plan (Los Angeles, CA)
- …referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent ... admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires… more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- …with consulting specialty services is required; Experience supervising physicians and supporting utilization management as a Physician Utilization Management ... L. Pettis Memorial Veterans Hospital is recruiting for a Full-Time, Permanent, Physician , Chief of Inpatient Medicine and reports directly to the ED-Inpatient… more
- Sharp HealthCare (San Diego, CA)
- …Will Do** The position is responsible for the medical direction of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all ... authorization review . + California Physicians and Surgeons License - Medical Board of CA - REQUIRED **Other Qualification Requirements** + Board Certification… more
- Veterans Affairs, Veterans Health Administration (Fresno, CA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... become available.** VA offers a comprehensive total rewards package. VHA Physician Total Rewards. Recruitment Incentive (Sign-on Bonus): Authorized Education Debt… more
- The County of Los Angeles (Los Angeles, CA)
- …and service or the utilization of personnel. + Plans, directs and supervises medical research and the presentation and review of findings. + Reviews the care ... more designated specialties,* or equivalent certification** -AND- Two years of medical administrative experience. LICENSE: California State Physician and… more