- Molina Healthcare (Los Angeles, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Managed Care Utilization Management and knowledge ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Elevance Health (Cerritos, CA)
- … criteria and relevant Carelon Medical Benefits Management policies pertaining to utilization review . + Demonstrate and maintain knowledge of applicable ICD-10, ... Ability to work in a dynamic, fast-paced environment + Preferred interest in Surgical utilization review + Strong analytical skills + Ability to multi-task +… more
- Elevance Health (Cerritos, CA)
- …Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and ... imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology,… more
- Elevance Health (Los Angeles, CA)
- …+ Requires HS diploma or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and ... **Be Part of an Extraordinary Team** **Medical Management Clinician Senior** **Location: Remote -** Candidates must reside within 50 miles or 1-hour commute each way… more
- Elevance Health (Los Angeles, 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 ... be considered. This position will work a hybrid model ( remote and office). The ideal candidate will must live...programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor… more
- Elevance Health (Cerritos, CA)
- …to work in a dynamic, fast-paced environment. + Preferred interest in Sleep management utilization review . For candidates working in person or remotely in the ... imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical necessity of outpatient radiology, cardiology,… more