- Kepro (Los Angeles, CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a ... Utilization Clinical Reviewer , you'll harness...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the esteemed California Mental… more
- Kepro (Los Angeles, CA)
- …for health solutions in the public sector. Position Overview: As a Utilization Reviewer , you involves reviewing medical records against appropriate criteria ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- Providence (Mission Hills, CA)
- …retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all ... payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization … more
- Molina Healthcare (Long Beach, CA)
- …non- clinical team activities to facilitate integrated proactive care review and management. + Develops, performs, and promotes interdepartmental integration and ... This is a fully remote role. The Director of Healthcare Services position...of Healthcare Services position will be overseeing the Outpatient Utilization Management Team. Candidates must have an active California… more
- Cedars-Sinai (Los Angeles, CA)
- …The Enterprise Information Services (EIS) team at Cedars-Sinai understands that true clinical transformation and the optimization of a clinical information ... " list, which highlights hospitals that have excelled in the utilization of electronic functionalities, telemedicine, digital imaging, artificial intelligence and… more
- Elevance Health (Woodland Hills, CA)
- … clinical operations department. Manages the delivery of quality care management, clinical utilization , and referral services. **How you will make an ... **Location:** This position will work in a hybrid model ( remote and office). The ideal candidate must live within...the scope of practice that is relevant to the clinical areas under review . + Identifies areas… more
- Molina Healthcare (Long Beach, CA)
- …are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED...to work some weekends and holidays. This is a remote position and you may work from home. Please… more
- LA Care Health Plan (Los Angeles, CA)
- Clinical Quality Program Manager II (CAHPS) Job Category: Clinical Department: Quality Improvement Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an...conditions and sincerely held religious beliefs. LA Care will review all exemption requests prior to proceeding with the… more
- Molina Healthcare (Los Angeles, CA)
- …will move to a 3 day/12 hour shift from then on._** **_Previous experience with Utilization Management / Utilization Review is very essential to this role. ... Experience with Case Management is a plus._** **_This is a remote role (work from home). Excellent computer multi-tasking skills and analytical thought process is… more
- Elevance Health (Woodland Hills, CA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor... program. **This position will work a hybrid model ( remote and office). The ideal candidate will live within… more
- Elevance Health (Woodland Hills, CA)
- …+ Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information. + ... I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50...HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of… more
- Insight Global (Long Beach, CA)
- Job Description Insight Global is looking for a passionate and experienced Care Review Clinician to join their team. This role will be remote working off of PST ... cost effectiveness, and compliance with all state and federal regulations; analyze clinical service requests from members or providers against evidence based … more
- Teleflex (Los Angeles, CA)
- …Operations and Corporate Accounts leaders and team members, providing field sales / clinical insight in order to best serve client needs as product portfolio and ... * Build performance-based relationships with leaders and team members in Clinical and Medical Affairs, Customer Service, and Distribution Operations to foster… more