- Elevance Health (Walnut Creek, CA)
- …+ Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + ... Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted… more
- The County of Los Angeles (Los Angeles, CA)
- …nursing, and administration. Incumbents seek the expert opinion or advice of a physician whenever the incumbent determines if a case falls outside the scope ... protocol. The Nurse Practitioner plans and implements and a physician reviews and confirms health care goals for patients....management as well as any subsequent modification. Incumbents may review use and effects of psychotropic drugs and other… more
- Travelers Insurance Company (Sacramento, CA)
- …Medical Consortiums and other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. ... which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical… more
- Humana (Sacramento, CA)
- …health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present educational… more
- The County of Los Angeles (Los Angeles, CA)
- …through university affiliations for interns, residents and fellows to train the physician workforce for tomorrow. THE MISSION: "To advance the health of our ... implements health care goals which are reviewed and approved by the physician . Essential Job Functions + Conducts comprehensive physical examinations, diagnoses and… more
- UCLA Health (Los Angeles, CA)
- …external, to assist patients with discharge/post hospital care + Interact closely with Utilization Review and Patient Business Services to ensure correct and ... + Working knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up + Working knowledge… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... patient's problem and routes to physicians.Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with physician… 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 ... of the Medical Director for John George Psychiatric Hospital by leading physician services specific to acute psychiatric care. 3. Liaison with Alameda County… more
- Stanford Health Care (Palo Alto, CA)
- …+ ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. + ... Line Outcomes Lead is responsible for partnering with service line & physician leadership to optimize documentation tools, improve processes, and develop strategies… more
- Banner Health (Susanville, CA)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... direction and supervision of a registered nurse and/or licensed physician , and is accountable for the quality of nursing...orders, within scope of practice. Provides care based on physician orders and the nursing plan of care, in… more