- Sharp HealthCare (San Diego, CA)
- …pre-admission review , utilization management, and concurrent and retrospective review Process. Performs and mentor's physician training of A&G and UM ... and oversight for Sharp Health Plan's (SHP) physicians ( Medical Directors (both medical and behavioral health) and the Physician Reviewers) to coordinate the… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... physician groups through the end of December 2022. Medical Director, Ventura County Health Care Plan Under general...care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review … more
- HCA Healthcare (Riverside, CA)
- …will serve as a consultant to hospital Medical Staff Services regarding physician credentialing, utilization , and quality profiling. Serves as a member of ... a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in… more
- Centene Corporation (Sacramento, CA)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Evolent (Sacramento, CA)
- …education and findings with matrixed Physician Business Manager. + Provides medical direction to the support services review process. Responsible for the ... of the Medical leadership team, providing timely medical review of service requests. Oversees the...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more