- LA Care Health Plan (Los Angeles, CA)
- Physical Accessibility Review Survey Reviewer II Job Category: Clinical Department: Facility Site Review Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Physical Accessibility Review Survey (PARS) Reviewer II is responsible...PARS assessments, FSR Survey up to 150 points, and Medical Record Review up to 30 charts.… more
- Evolent (Sacramento, CA)
- …Stay for the culture. **What You'll Be Doing:** As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can ... needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not...an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed, will make denial determinations… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …AND PURPOSE Under the direction of a Quality Assurance Coordinator, the Quality Assurance Reviewer I performs Quality Assurance review and audit of VOALA Program ... Quality Assurance Reviewer Location:Los Angeles, CA Job ID:4493 Salary:$24.84 -...funder audits and ensure all requirements are in place. Review audit results from funders- audits. Participate in after… more
- Elevance Health (Los Angeles, CA)
- …+ Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. ... with a comp day during the week)** The **Nurse Reviewer I** will be responsible for conducting preauthorization, out...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial … more
- Elevance Health (Los Angeles, CA)
- The **Therapy Services Reviewer ** is responsible for the review of medical records to determine if requests for therapy services (physical therapy, ... requirements. . Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. . Acts as a resource for internal and… more
- Evolent (Sacramento, CA)
- …Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. ... the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are… more
- Evolent (Sacramento, CA)
- …improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may ... patients as directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers...to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory… more
- STG International (San Francisco, CA)
- STGi is currently seeking a Medical Assistant- Case Review Specialist to support our Federal Occupational Health (FOH) contract in San Francisco, CA. The ... will ensure that complete exams are sent to the Reviewing Medical Officer (RMO) for review in a timely manner via secure transmission. The RMO determinations… 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 ... **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful… 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 ... culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management, you will be a key...reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more