- Highmark Health (Austin, TX)
- …**JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team… more
- Highmark Health (Austin, TX)
- …itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education ... successful and measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes qualitative and… more
- Highmark Health (Austin, TX)
- …internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy and ... Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required....position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Austin, TX)
- …agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees. ... designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution. Interpret… more
- The Cigna Group (Plano, TX)
- …several health -related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, ... **JOB SUMMARY** The Director Health Systems Sales will lead a Sales Manager...training. Conduct training sessions as needed. + Ensure the utilization and accuracy of data in the Saleforce system.… more
- HCA Healthcare (Austin, TX)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... or limits? Our St. David's Healthcare team is looking for a(an) Employee Health Nursing Manager. HCA Healthcare is an advanced healthcare network that has committed… more
- HCA Healthcare (Austin, TX)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care… more
- Texas Health Resources (Arlington, TX)
- …We offer advanced care in medical and surgical services, cancer treatment, women's health , behavioral health , neurosciences, emergency and sports medicine. ... for qualified candidates like you to join our Texas Health family._ + Work location: Texas Health ...this purpose. Provide resources and guidance to support the utilization of evidence based practice standards. Identify and utilize… more
- Elevance Health (TX)
- …law._ The **Medical Director** is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. + Identifies and...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Lamesa, TX)
- …the identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs… more