- Evolent (Sacramento, CA)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially...MD review process to reflect appropriate utilization and … more
- Evolent (Sacramento, CA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the MD ... reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...review process to reflect appropriate utilization and … more
- Meta (Menlo Park, CA)
- …Ensure adherence to defined standards in order for Meta to maintain legal and regulatory compliance 15. Create & facilitate presentations to support execs / ... project plans for supported program(s) 4. Support execution of risk and compliance related activities including statutory risk assessments, regulatory requests… more
- Gilead Sciences, Inc. (Oceanside, CA)
- …Partner with Legal, HR, Regulatory , and Commercial teams to ensure compliance across business functions, including review of promotional materials and ... performance evaluations, and long-term career development. The Director ensures compliance with global regulatory requirements, marketing authorization holder… more
- Evolent (Sacramento, CA)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** As a Field Medical Director, Physical Medicine and Rehab you will be...MD review process to reflect appropriate utilization and … more
- Robert Half Accountemps (San Diego, CA)
- Description Are you a highly skilled and motivated medical billing professional with extensive knowledge of Medicaid and Medicare processes? Our client is currently ... seeking a Senior Medical Billing Specialist to lead their billing team and...lead their billing team and ensure the accuracy and compliance of claims submissions. This role is ideal for… more
- IQVIA (Los Angeles, CA)
- …and conduction of advisory boards. + Consult with physicians, pharmacists, and other medical professionals, in compliance with relevant laws and regulations, to ... Our collaborative teams play a vital role in ensuring that biopharmaceuticals, medical devices, patient support services reach those who need them. We offer… more
- Providence (CA)
- …Program:** + Communicate with patients, claimants, caregivers, providers, leadership + Review and analyze medical records, interview witnesses, assist with ... to address coverage + Set appropriate indemnity and expense reserves + Select appropriate medical experts for case review + Develop a plan of action for… more
- BD (Becton, Dickinson and Company) (San Diego, CA)
- …their reports. **Responsibilities:** + Lead and develop direct report associates to ensure regulatory compliance + Problem solve and escalate regulatory and ... (510(k), Technical Files, etc.) + Develop and implement global regulatory strategy for MMS Dispensing Medical Device...for change controls and other RA/QA items from a review and approve level + Assists in preparing, auditing,… more
- Humana (Sacramento, CA)
- …will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... 48 states. **Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills… more