- Elevance Health (Walnut Creek, CA)
- …the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts ... **Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery** **Carelon Medical...peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines… more
- Humana (Sacramento, CA)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- Alameda Health System (San Leandro, CA)
- …staff, visitors, and volunteers. 8. Assures that the facility complies with all utilization review and case management requirements of Alameda County, AHS, and ... Medical Director, John George Psychiatric Hospital + San... Director for John George Psychiatric Hospital by leading physician services specific to acute psychiatric care. 3. Liaison… more
- Alameda Health System (Oakland, CA)
- …Responsible for the coordination and support of the AHS Utilization Review Committee. + Responsible for overseeing patient, physician and staff satisfaction ... the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to...Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may… more
- Veterans Affairs, Veterans Health Administration (Santa Rosa, CA)
- …Scopes of Practice: The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules… more
- Highmark Health (Sacramento, CA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, member facing outreach initiatives… more
- Elevance Health (Palo Alto, CA)
- …**Carelon Medical Benefits Management** **Post Acute Care Benefit Utilization Management** **Schedule: 10:00-7:00 Central Time** **** **Virtual:** This role ... board certified specialty. + Makes physician to physician calls to gather medical appropriate information...decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director … more
- Sharp HealthCare (San Diego, CA)
- …when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly ... + Data collectionParticipates in data and statistics collection as requested by Utilization Review , Service Line and Quality Improvement Committees. + Denial… more
- Dignity Health (Bakersfield, CA)
- … review medical records, authorize requested services and prepare cases for physician review based on medical necessity. The position partners with ... and internal staff to coordinate patient care. - Promotes quality, cost effective medical care through strict adherence to all utilization management policies… more