CEDARS-SINAINewRN Case Manager - Case Management (ED) - Per Diem (12-hour night shifts) - Marina Hospital CEDARS-SINAIRN Case Manager - Case Management (ED) - Per Diem (12-hour night shifts) - Marina HospitalMarina Del Rey, CASee CEDARS-SINAI Terms & Conditions at http://www.cedars-sinai.edu/Website-Terms-and-Conditions.aspx and Privacy Policy at http://www.cedars-sinai.edu/Privacy-Policy.aspx and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Cedars Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles.
CEDARS-SINAINewRN Case Manager - Case Management - Part time - Day Shift - Marina del Rey Hospital CEDARS-SINAIRN Case Manager - Case Management - Part time - Day Shift - Marina del Rey HospitalMarina Del Rey, CASee CEDARS-SINAI Terms & Conditions at http://www.cedars-sinai.edu/Website-Terms-and-Conditions.aspx and Privacy Policy at http://www.cedars-sinai.edu/Privacy-Policy.aspx and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Cedars Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles.
Acentra HealthNewClinical Reviewer - RN - PRN (Remote U.S.) Acentra HealthClinical Reviewer - RN - PRN (Remote U.S.)CARemote$28.37–$36 / hourIn fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Responsibilities: Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services.
Acentra Health, LLCClinical Reviewer (LMFT or LCSW) - Remote in CA Acentra Health, LLCClinical Reviewer (LMFT or LCSW) - Remote in CACaliforniaRemote$28.37–$41 / hourMust hold an active California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social Worker (LCSW) and a master’s degree in a directly related field from an accredited institution. Proactively assess, prioritize, and manage daily workloads and review queues, adjusting work schedules as needed to effectively meet departmental demands.
Acentra HealthClinical Reviewer - (Remote in California) Acentra HealthClinical Reviewer - (Remote in California)CARemote$28.37–$39.19 / hourMust hold an active California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social Worker (LCSW) and a master's degree in a directly related field from an accredited institution. Proactively assess, prioritize, and manage daily workloads and review queues, adjusting work schedules as needed to effectively meet departmental demands.
CVS Health CorpPrior Authorization Clinical Reviewer CVS Health CorpPrior Authorization Clinical ReviewerCA$26.01–$74.78 / yearApplication of critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for members with disabilities and special healthcare needs. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Epic CareInsurance Reviewer-Clinical Epic CareInsurance Reviewer-ClinicalAntioch, California$25.75–$33.60 / hourWhile performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment.
US Oncology IncInsurance Reviewer-Clinical US Oncology IncInsurance Reviewer-ClinicalAntioch, CACookies are used on this site to assist in continually improving the candidate experience and all the interaction data we store of our visitors is anonymous. We're sorry, but it looks like this job may be no longer available or does not exist.
Evolent Health IncPhysician Reviewer Internal Medicine-Field Medical Director, Radiology (Part Time) Evolent Health IncPhysician Reviewer Internal Medicine-Field Medical Director, Radiology (Part Time)Work at Home, CA$95–$100 / hourNot under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. What You Will Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Evolent Health IncOtolaryngologist-Physician Reviewer-Field Medical Director, Radiology (Full-Time) Evolent Health IncOtolaryngologist-Physician Reviewer-Field Medical Director, Radiology (Full-Time)Work at Home, CA$95–$109 / hourNot under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. What You Will Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Evolent Health IncEndocrinology-Physician Reviewer-Field Medical Director, Radiology (Full-Time) Evolent Health IncEndocrinology-Physician Reviewer-Field Medical Director, Radiology (Full-Time)Work at Home, CA$95–$109 / hourNot under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. What You Will Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Managed Medical Review OrganizationNeurologist -Independent Medical Reviewer Managed Medical Review OrganizationNeurologist -Independent Medical ReviewerAnaheim, CAManaged Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide. Board Certification: Maintained certification by a board recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).
Macpower Digital Assets Edge Private LimitedHealthcare Compliance Trainer & Regulatory Site Reviewer (DHCS Certified Master Trainer) Macpower Digital Assets Edge Private LimitedHealthcare Compliance Trainer & Regulatory Site Reviewer (DHCS Certified Master Trainer)Pleasanton, CA$180,000–$256,000 / yearAbout the Role: We're looking for a certified healthcare compliance professional to lead quality reviews and ensure our facilities meet all state and federal regulations. Compliance Leadership Perform state-required facility surveys (FSR/MRR/PAR).
Elevance Health IncPsychologist Reviewer Elevance Health IncPsychologist ReviewerWoodland Hills, CA$93,120–$167,616 / yearPartners with Behavioral Health Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing. D in clinical/counseling psychology and managed care experience which includes experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background.
Adverum Biotechnologies IncQC Analyst II/III Reviewer (Contract) Adverum Biotechnologies IncQC Analyst II/III Reviewer (Contract)Redwood City, CA$40–$50 / hourAs a vital member of the Quality Control unit, the analyst will play a significant role in advancing and performing Quality Control (QC) review of different assay techniques, systems, policies, processes, procedures, and controls pertinent to the analytical examination of clinical materials. Leveraging the research capabilities of its proprietary intravitreal (IVT) platform, Adverum is developing durable, single-administration therapies designed to be delivered in physicians' offices to eliminate the need for frequent ocular injections to treat these diseases.
Vivo HealthStaffUtilization Review Clinical Manager - Denials (Registered Nurse) Vivo HealthStaffUtilization Review Clinical Manager - Denials (Registered Nurse)Burbank, CAVivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States. Oversee both licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and any necessary disciplinary actions.
Vivo HealthStaffUtilization Review Clinical Supervisor - Denials (Registered Nurse) Vivo HealthStaffUtilization Review Clinical Supervisor - Denials (Registered Nurse)Burbank, CAVivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States. Supervise licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and disciplinary actions.
ExamWorks Group IncNewClinical Quality Assurance Nurse Auditor (32292) ExamWorks Group IncClinical Quality Assurance Nurse Auditor (32292)Redding, CA$34–$35 / hourEvaluates clinical information received, writes and/or reviews various reports including Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements. ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services.
Cohere Health Technologies LLCClinical Policy Configuration Specialist Cohere Health Technologies LLCClinical Policy Configuration SpecialistCARemote$70,000–$80,000 / yearBacked by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. By unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
Capgemini SESenior Consultant - Life Sciences, Clinical Data & Applications (R&D) Capgemini SESenior Consultant - Life Sciences, Clinical Data & Applications (R&D)San Francisco, CA$112,600–$160,000 / yearIt delivers end-to-end services and solutions leveraging strengths from strategy and design to engineering, all fueled by its market leading capabilities in AI, generative AI, cloud and data, combined with its deep industry expertise and partner ecosystem. Leaders in digital transformation, the team has helped clients establish innovation incubators, develop digital medicine strategies, enhance patient experiences, and identify new revenue sources.
Capgemini SENewConsultant - Life Sciences, Clinical Data & Applications (R&D) Capgemini SEConsultant - Life Sciences, Clinical Data & Applications (R&D)San Francisco, CA$112,600–$160,000 / yearIt delivers end-to-end services and solutions leveraging strengths from strategy and design to engineering, all fueled by its market leading capabilities in AI, generative AI, cloud and data, combined with its deep industry expertise and partner ecosystem. Leaders in digital transformation, the team has helped clients establish innovation incubators, develop digital medicine strategies, enhance patient experiences, and identify new revenue sources.
AHMC HealthcareCLINICAL DIETITIAN (SNF) AHMC HealthcareCLINICAL DIETITIAN (SNF)Daly City, CaliforniaA Bachelor’s degree in Dietetics or equivalent from an approved program that meets the American Dietetic Association qualifications for Registered Dietitian or Registered Dietitian eligibility. 9 Evaluates effects of nutritional intervention on individual patients/residents nutritional status to determine need of further intervention or revision of nutritional care plan.
AkidoNewClinical Review Nurse - Prior Authorization AkidoClinical Review Nurse - Prior AuthorizationChino, CA$62,400–$93,600 / yearServing 500K+ patients across California, Rhode Island, and New York, Akido offers primary and specialty care in 26 specialties—from serving unhoused communities in Los Angeles to ride-share drivers in New York. Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America's physician shortage and make exceptional healthcare universal.
Vivo HealthStaffUtilization Review RN (Hybrid) Vivo HealthStaffUtilization Review RN (Hybrid)SF, CAConfers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care. Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high quality, cost effective manner.
Evolent Health IncField Medical Director, MSK Surgery (Orthopedic Surgery) Evolent Health IncField Medical Director, MSK Surgery (Orthopedic Surgery)CAWhat You Will Be Doing: • Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. • Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is highly preferred Minimum of five (5) years' experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is highly preferred.
Evolent Health IncPain Management Physician Field Medical Director, IPM Evolent Health IncPain Management Physician Field Medical Director, IPMWork at Home, CA$100–$110 / hourWhat You Will Be Doing: Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
PeopleNTech LLCTapestry UM Analyst PeopleNTech LLCTapestry UM AnalystSanta Clara, CAConfigure and optimize Tapestry UM workflows for prior authorizations (e.g., medical, behavioral health, pharmacy-to-medical crossovers) and referrals (in- and out-of-network), including routing rules, WQs, templates, smart text, decision trees, and notification logic. You will partner with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to enable compliant, efficient, and transparent UM determinations that reduce administrative burden and improve member and provider experience.
DOMA TechnologiesRheumatologist (actively practicing) for remote PRN peer reviews DOMA TechnologiesRheumatologist (actively practicing) for remote PRN peer reviewsCARemote$750–$2,000We're growing our network of clinical reviewers and are actively seeking Rheumatologists (must be actively practicing) who are passionate about quality, accountability, and patient outcomes. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.
eTeam Inc.RN Quality and Patient Safety Specialist/Clinician eTeam Inc.RN Quality and Patient Safety Specialist/ClinicianModesto, CAClinical Effectiveness Consultant IIL supports the hospital’s Quality and Patient Safety program by coordinating and managing the clinical peer review process. This role facilitates case identification, case preparation, reviewer assignment, and documentation to ensure timely and compliant peer review activities.
Evolent Health IncField Medical Director, Vascular Surgery (Part-time or Full-time) Evolent Health IncField Medical Director, Vascular Surgery (Part-time or Full-time)Work at Home, CA$130–$140 / hourWhat You Will Be Doing: Serve as the specialty match reviewer in Vascular cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
Evolent Health IncField Medical Director, Radiation Oncology (full-time or part-time) Evolent Health IncField Medical Director, Radiation Oncology (full-time or part-time)Work at Home, CA$130–$140 / hourNot under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. What You Will Be Doing: Serve as the Physician match reviewer in Radiation Oncology and imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Evolent Health IncCoordinator, UM Intake Evolent Health IncCoordinator, UM IntakeWork at Home, CATechnical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. What You'll Be Doing: The Coordinator, Intake Utilization Management at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements.
MODERN MED HEALTH SOLUTIONSNurse Practitioner MODERN MED HEALTH SOLUTIONSNurse PractitionerFresno, CA$800–$800 / dayJob Description: As a trusted partner in performing Compensation & Pension (disability) examinations for Veterans, Modern Med Health Solutions is seeking a part-time Nurse Practitioner/ Physician Assistant to join our team. Training: MMHS offers additional 1:1 virtual clinical support for completing examinations with our Provider Training Specialist.
Sutter HealthMedical Social Worker, Per-Diem Sutter HealthMedical Social Worker, Per-DiemSanta Rosa, CA$46.52–$62.50 / hourTotal compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Works closely with Clinical Reviewers to achieve the highest quality care and service and the best possible outcomes in a cost-effective manner.
Sutter HealthMedical Social Worker Per-Diem Sutter HealthMedical Social Worker Per-DiemSanta Rosa, CA$46.52–$62.50 / hourTotal compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Works closely with Clinical Reviewers to achieve the highest quality care and service and the best possible outcomes in a cost-effective manner.
Bakersfield Behavioral Healthcare HospitalRegistered Nurse | Admissions/Intake (PER DIEM) Bakersfield Behavioral Healthcare HospitalRegistered Nurse | Admissions/Intake (PER DIEM)Bakersfield, CA$91,520–$127,670Someone capable of displaying basic knowledge of treatment procedures; interventions common to acute psychotic as well as non-violent crisis intervention practice; A person with basic knowledge of abnormal psychology, application of this knowledge to the care of our patients, and fluency in medical terminology in psychiatric care; Someone with thorough familiarity of psych and the use of psychotropic medications, basic teaching and training skills helpful; problem-solving; An organized individual with exceptional organizational and time management skills; crisis intervention skills; Someone with strong written and oral communication skills in the English language; skills in facilitating and/or co-facilitating process-oriented and didactic groups. POSITION SUMMARY: The Admissions RN (Intake Packet Reviewer) is responsible for conducting comprehensive clinical reviews of referral packets to determine patient eligibility for admission to Bakersfield Behavioral Healthcare Hospital (BBHH).
Arrowhead PharmaceuticalsNewManager, Marketing (Consumer) Arrowhead PharmaceuticalsManager, Marketing (Consumer)Pasadena, CA$120,000–$145,000 / yearThe Consumer Marketing Manager Manager at Arrowhead Pharmaceuticals will play a critical role in driving Arrowhead's brand strategy across consumer/patient marketing on our cardiometabolic team serving patients living with Familial Chylomicronemia Syndrome (FCS) and Severe Hypertriglyceridemia (SHTG). Arrowhead is leading the field in bringing the promise of RNAi to address diseases outside of the liver, and our clinical pipeline includes disease targets in the liver and lung with a promising pipeline of preclinical candidates.
Cedars-Sinai Medical CenterRN Case Manager - Case Management (ED) - Per Diem (12-hour night shifts) - Marina Hospital Cedars-Sinai Medical CenterRN Case Manager - Case Management (ED) - Per Diem (12-hour night shifts) - Marina HospitalMarina del Rey, CAPrimary Duties and Responsibilities: • Performs evaluation and or assessment within the established/communicated timeframe • Documents appropriate reviews for assigned patients using utilization review tool • Provides telephonic review for identified contracted/private patients • Collaborates with on-site and/or outside reviewers • Keeps patients informed of progress and provides information related to disease progression • Collaborates with discharge planner to make orders and arranges for home care equipment, healthcare needs, and works with third-party payers to validate orders • Educates patients and families on all aspects of patients' hospitalization and continuing care • Assumes responsibility for timely completion of required case management reports for regulatory bodies, health plans, and insurance carriers • Interacts professionally with patient/family/caregivers and involves them in the formation of the plan of care and discharge needs • Coordinates with multidisciplinary team to ensure the identification of a safe and appropriate discharge plan for each assigned patient • Maintains department cleanliness and safety. Cedars Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles.
Alura Workforce SolutionsGrievance and Appeals Nurse-LVN 26-00152 Alura Workforce SolutionsGrievance and Appeals Nurse-LVN 26-00152Rancho Cucamonga, CAThe Grievance & Appeals Nurse is responsible for working directly with the IPAs, Hospitals, internal departments, and the grievance team to ensure grievance and appeal cases are processed per the Grievance Policy & Procedures and Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations and NCQA. Ensure clinical oversight of assigned Grievance and Appeals team cases, to include final nurse review of all Non-Quality of Care grievance and appeals cases and thorough investigation of all Quality-of-Care cases to be reviewed by IEHP Medical Director and designated Nurse Reviewer.
Sutter HealthMedical Social Worker II, Per-Diem Sutter HealthMedical Social Worker II, Per-DiemVallejo, CA$53.37–$72.04 / hourTotal compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Works closely with Clinical Reviewers to achieve the highest quality care and service and the best possible outcomes in a cost-effective manner.
eTeam Inc.Utlization Review RN eTeam Inc.Utlization Review RNOrange, CA$60–$65 / hourCandidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Pre-approved time off per contract no to exceed 5 days.
eTeam Inc.Utilization Review RN eTeam Inc.Utilization Review RNOrange, CACandidate must be highly proficient in EPIC and InterQual, with demonstrated experience using both systems for clinical review and medical necessity determination. Shift: Day 5x8-Hour (09:00 - 17:30) .
Blue Cross and Blue Shield AssociationMedical Director, Utilization Management - Commercial Prior Authorization Review Blue Cross and Blue Shield AssociationMedical Director, Utilization Management - Commercial Prior Authorization ReviewSan Diego, CADemonstrated proficiency in at least three of the following: MEDICARE/MEDICARE STARS, Dual Special Needs Plan (D-SNP), MEDI-CAL, NCQA/URAC/Quality Programs, Policies/Procedure development, Clinical Subject Matter Expert for Litigation, SIU/Waste/Fraud/Abuse, Appeals/Grievances, Case Management/Population Health, Federal Employee Program (FEP), Education/Training (DELIVERS CME, CEU), Quality Improvement. Support Vice President, Medical Director in strategic initiatives whether by proposing clinical initiatives, providing expert input, shaping the strategy, and/or serving as the initiative driver.
Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR II Los Angeles CountyUTILIZATION REVIEW NURSE SUPERVISOR IILos Angeles, CA$118,457.04–$177,314.88 / yearVeteran's Credit: Pursuant to the County Charter and County policy, in all open competitive examinations (i.e., examinations open to everyone), the County of Los Angeles will add a credit of 10 percent of the total credits specified for such examination to the final passing score of an honorably discharged veteran, as well as the spouse of a deceased or disabled veteran, who served in the Armed Forces of the United States under specific conditions. Under the direction of a physician member of the Utilization Review Committee, the incumbent is responsible for the development and implementation of procedures for and the effective conduct of the system to review patients medical charts to ascertain the medical necessity for services and appropriateness of the level of care, for notification of appropriate persons of cases which do not meet medical necessity and level of care criteria, and for certification of approved hospital days reimbursable under the Medicare and MediCal programs.
MODERN MED HEALTH SOLUTIONSPhysician Assistant MODERN MED HEALTH SOLUTIONSPhysician AssistantFresno, CA$800–$800 / dayJob Description: As a trusted partner in performing Compensation & Pension (disability) examinations for Veterans, Modern Med Health Solutions is seeking a part-time Nurse Practitioner/ Physician Assistant to join our team. Training: MMHS offers additional 1:1 virtual clinical support for completing examinations with our Provider Training Specialist.
Iovance Biotherapeutics IncNewRegulatory Affairs CMC Associate II Iovance Biotherapeutics IncRegulatory Affairs CMC Associate IISan Carlos, CARemote$120,000–$140,000 / yearWorks with submission authors and reviewers to ensure that source document planning is complete and that high-quality documents are approved on-schedule in terms of scientific content, organization, clarity, accuracy, format, consistency and adherence to regulatory guidelines, styles and processes. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem-solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Iovance Biotherapeutics IncNewSenior Regulatory Affairs CMC Associate Iovance Biotherapeutics IncSenior Regulatory Affairs CMC AssociateSan Carlos, CARemote$140,000–$160,000 / yearWorks with submission authors and reviewers to ensure that source document planning is complete and that high-quality documents are approved on-schedule in terms of scientific content, organization, clarity, accuracy, format, consistency and adherence to regulatory guidelines, styles and processes. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem-solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
CorVel CorpProfessional Review Nurse CorVel CorpProfessional Review NurseFolsom, CARemote$70,304–$85,473 / yearUtilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: • Duplicate billing • Unbundling of charges • Services not rendered • Mathematical and data entry errors • Undocumented services • Reusable instrumentation • Unused services and supplies • Unrelated and/or separated charges • Quantity and time increment discrepancies • Inconsistencies with diagnosis • Treatment frequency and duration of care • DRG validation • Service/treatment vs. KNOWLEDGE & SKILLS: • Concise and effective verbal and written communication skills • Ability to interface with claims adjusters, attorneys, physicians and their representatives, advisors/clients, and co-workers • Ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management • Strong ability to effectively negotiate provider fees • Must be proficient with Microsoft Office applications • Knowledge of workers compensation claims preferred.
ConcentraNewOrthopedic Surgeon Telecommute Medical Review Stream Physician ConcentraOrthopedic Surgeon Telecommute Medical Review Stream PhysicianSan Francisco, California$30–$90 / hourCurrent, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. This position is eligible to earn a base compensation rate in the state range of $30.00 to $90.00 hourly depending on job-related factors as permitted by applicable law, such as level of experience, geographic location where the work is performed, and/or seniority.
ConcentraNewPhysical Medicine & Rehabilitation Telecommute Medical Review Stream Physician ConcentraPhysical Medicine & Rehabilitation Telecommute Medical Review Stream PhysicianSacramento, CaliforniaCurrent, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care JOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills -Demonstrated ability to perform review services.