Clinical Reviewer - California

The Clinical Data Review Coordinator is essential to UCLA Health's commitment to excellence.Your work ensures that the data driving our quality metrics is reliable, actionable, and aligned with regulatory expectations—ultimately supporting better outcomes for the patients and com ...

UCLA Health is seeking a detail-oriented and mission-driven Clinical Data Review Coordinator to support our quality reporting and regulatory compliance efforts. · ...

The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims member grievances appeals and quality-of-care concerns. · ...

The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims, member grievances, appeals, and quality-of-care concerns.Using clinical judgment and appropriate application of CMS regulations, Medicare Advantage requirements, an ...

We are seeking a Clinical Review Nurse to evaluate medical records and clinical documentation to support the resolution of claims, member grievances, appeals, and quality-of-care concerns.The Clinical Review Nurse applies clinical acumen to assess medical necessity, appropriatene ...

The Clinical Consultant – RN provides clinical leadership, consultation, and oversight across care management programs. · ...

+You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. · +Evaluate clinical program effectiveness · Make recommendations to optimize clinical programs · +Md or DO with an active medical license · ...

About Stella's IOPStella's Intensive Outpatient Program (IOP) is a fully virtual program for patients located in California. Our curriculum blends evidence-based psychotherapy... · We are seeking a Utilization Review (UR) Manager who will play a critical role in ensuring timely p ...

We are seeking a Utilization Review (UR) Manager who will play a critical role in ensuring timely patient access to care while maintaining strong payer relationships and regulatory compliance. This role is responsible for managing all utilization review functions for patients adm ...

A Medical Center facility under the aegis of California Public Ivy university seeks an accomplished Utilization Review Nurse in Los Angeles CA % REMOTE). · The ideal candidate is a California licensed RN who can independently review clinical documentation, · apply evidence-based ...

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. · ______________________________________ · NOTE- THIS IS 100% REMOTE ROLE & ONLY W ...

Job Description · Compliance & Policies: · IRB: Intern will need to be added to the IRB study. · IACUC: Intern will need to be added to the IACUC study. · Clinical Research: Review updated guidance for inclusion of interns in clinical research prior to beginning any activities. L ...

This position combines clinical, business, and regulatory knowledge to reduce financial risk through denials management.Reviews denials for level of care, medical necessity. · Coordinates appeal strategies with physicians and payors. · ...

At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. · ...

The Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality care at UCLA Health. · ...

The Compliance Manager is responsible for ensuring that all healthcare providers within the practice adhere to established clinical regulatory organizational standards. · Bachelor's degree in Healthcare Administration Nursing Public Health Compliance related field Master's prefer ...

The Compliance Manager ensures all healthcare providers adhere to established clinical standards while working closely with the Chief Medical Officer. · ...

Eisner Health is seeking a Clinical Director who will supervise the licensed clinical staff within their department as well as provide direct care. · ...

The Senior Clinical Trial Manager is responsible for the successful execution of clinical trials from protocol concept to completion. · Manages all clinical aspects of a study. · Assesses operational feasibility and manages comprehensive study timelines and metrics. · Participate ...

+h2>Job summary · The Clinical Research Associate supports clinical trial execution by independently monitoring study sites and ensuring compliance with protocol GCP and regulatory requirements. · Perform site qualification initiation monitoring and close-out visits · Review sour ...

This role plays a critical part in advancing clinical trials. You will work closely with our Principal Investigator ensuring patient safety ,data integrity,and protocol excellence. · MD or NP with valid US/California medical license. · Perform physical exams. · Evaluate patient ...