- Dignity Health (Arnold, CA)
- …services provided; participate in annual review of patient health records and utilization review studies of the Clinic services + Maintain confidentiality of ... records are transferred as required when patients are referred; participate in an annual review for quality completeness + Is present in the Clinic at least once… more
- CVS Health (Sacramento, CA)
- …Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual ... Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for medical necessity ...based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols. + Serve… more
- Elevance Health (Costa Mesa, CA)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit** **Management/ Utilization ** ** Review ** **Virtual:** This role enables associates ... decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review... review decisions that require + Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD… more
- HCA Healthcare (San Jose, CA)
- …responsibility typically includes Accounting, Reimbursement, Managed Care, Health Information, and Utilization Review . Functions at an executive level in an ... administration, appropriate facility staff members and Division Office. + You will review denials issues and trends for maximizing net reimbursement for Facility.… more
- Actalent (Los Angeles, CA)
- …risk mitigation plans. + Manage program logistics, organization, safety, and manpower utilization . + Review and approve monthly invoices. + Ensure contractor, ... completion of all deliverables required by the client. + Develop and review contract documents to ensure compliance with construction and project requirements. +… more
- Dignity Health (San Andreas, CA)
- …provided; participate in annual review of patient health records and utilization review studies of the Clinic services. + Maintain confidentiality of ... PHI and ensure patient's right to privacy. + Obtain a health history and access the stated health of the patient in order to determine health care needs and document findings in the medical record. **We offer the following benefits to support you and your… more
- STG International (Corona, CA)
- …patient safety. *Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health ... of Quality Performance Improvement Team (QPIT) strategic initiatives. *Participate in review and improvement of clinical success in of areas of responsibility.… more
- Sharp HealthCare (San Diego, CA)
- …appeals and grievances. **Required Qualifications** + 3 years' experience in claims, utilization review , appeals or member services in a managed care ... in Commercial regulatory and accreditation audits. Pulls case files, completes quality review of documents and data files, participates in audit interviews to… more
- Elevance Health (Costa Mesa, CA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... PST and some Holidays. The **Med Management Nurse** will be responsible for review of the most complex or challenging cases that require nursing judgment, critical… more
- Ventura County (Ventura, CA)
- …in-services and staff development programs; + May participate in quality assurance/ utilization review or other non-direct patient care nursing assignments; ... we receive a sufficient number of qualified applications to meet business needs. FIRST REVIEW OF APPLICATIONS: May 29, 2025 Examples Of Duties Duties include but are… more