- 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
- Magellan Health Services (Long Beach, CA)
- …care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity ... members in the Medicaid, Medicare, and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews member… 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 (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