• Clinical Appeals Nurse (RN)

    Molina Healthcare (Houston, TX)
    …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...has been made or upon request by another Molina department to reduce the likelihood of a formal appeal… more
    Molina Healthcare (07/20/25)
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  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (TX)
    …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
    Molina Healthcare (07/19/25)
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  • Manager - Case Management & Social Services

    Houston Methodist (Sugar Land, TX)
    …incidental overtime and overtime percentage, and other areas according to department specifications. + Manages utilization management (UM) programs including ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...functional and operational aspects of the Case Mgmt./Social Work department , an integrated, interprofessional department which supports… more
    Houston Methodist (04/24/25)
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  • Manager Revenue Cycle - Self-pay…

    Houston Methodist (Katy, TX)
    At Houston Methodist, the Manager Revenue Cycle position is responsible for the daily management of the staff and operations for one or more of the following areas ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
    Houston Methodist (05/01/25)
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  • Valuations Funds Manager

    CBRE (Dallas, TX)
    Valuations Funds Manager Job ID 215004 Posted 11-Apr-2025 Service line Advisory Segment Role type Full-time Areas of Interest Valuations/Appraisal Location(s) Dallas ... - United States of America **About The Role:** As a CBRE Valuation Funds Manager , you will independently prepare market value appraisals on real estate assets with… more
    CBRE (06/27/25)
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  • Medical Director, MSK Surgery

    Evolent (Austin, TX)
    …to the support services review process. Responsible for the quality of utilization review determinations, including appeals . + Provides input into audit ... training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts… more
    Evolent (05/20/25)
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  • Case Management Coordinator - Days

    Houston Methodist (The Woodlands, TX)
    …clerical and data management support to the case management and social work department staff to facilitate efficient utilization of resources and discharge ... manage time effectively and prioritize daily tasks. Provides input into the department resource utilization including capital and operational budget needs as… more
    Houston Methodist (07/19/25)
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  • Case Management Rep

    Houston Methodist (Houston, TX)
    …assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning ... care benefits + Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies,… more
    Houston Methodist (07/18/25)
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