- Kepro (Los Angeles, CA)
- … Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you will leverage your expertise to meticulously assess ... will evaluate the medical necessity of psychiatric inpatient care to ensure appropriate utilization of services. This role is pivotal in maintaining the accuracy and… 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
- 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
- ThermoFisher Scientific (Long Beach, CA)
- …compliance and decrease risks. + Ensures data accuracy through SDR, SDV and CRF review as applicable through on-site and remote monitoring activities. + Assess ... step beyond through research, development and delivery of life-changing therapies. With clinical trials conducted in 100+ countries and ongoing development of novel… 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 (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