- Kepro (Anaheim, CA)
- Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you'll ... the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health...a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based… 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
- 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 (Los Angeles, CA)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... received. **Location:** This position will work a hybrid model ( remote and office) and must live within 50 miles...to improve quality, cost, and outcomes. + May provide clinical consultation and serve as clinical /strategic advisor… more
- Elevance Health (Costa Mesa, 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
- Molina Healthcare (Los Angeles, CA)
- …management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy ... **JOB DESCRIPTION** This position is remote and work hours are 10-6:30pm PST hours...services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight… more