- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... Provides clarity of clinical information used for measuring and reporting physician and medical center outcomes which incorporates current DRG methodologies (eg… 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
- Sharp HealthCare (La Mesa, CA)
- …procedures under the direction/supervision of the Radiation Safety Officer and Physician Authorized Users. Assist physicians with performing and viewing of NM ... correct billing codes and modifiers as appropriate.Demonstrate competency in utilization of computer applications including RIS, PACS, voice recognition,… more
- Cognizant (Sacramento, CA)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI… more
- VNA Health (Santa Barbara, CA)
- …organizes and directs home care services. Responsibilities: + Responsible for continuous review of all aspects of every patient on his/her caseload to include: ... appropriate utilization of services; ensuring continued skilled need; monitoring of...services; ensuring continued skilled need; monitoring of homebound status; review of documentation in the medical record; maintenance of… more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and… more
- Cognizant (Sacramento, CA)
- …experience. + Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Must be able to work with ... + A minimum of 2 years claim processing is required. + Knowledge of physician practice and hospital coding, and medical terminology, CPT, HCPCS, ICD-10 + Experience… more
- Elevance Health (Costa Mesa, CA)
- …plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + Negotiates ... providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires BA/BS in… 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 ... Thorough understanding of health services and delivery models, including hospital, physician , ancillary, home health, prescription drugs, etc. Knowledge of various… more
- Cardinal Health (Sacramento, CA)
- …regimens as insurance indicates + Discuss medication options with pharmacy/ physician and patient based on accessibility and availability (outpatient environment) ... regarding best demonstrated practices + Significantly influences customer acceptance and utilization of new products and services in multi-site and/or complex… more