• Payment Integrity Clinician

    Highmark Health (Austin, TX)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Medical Director, Medical Management

    Highmark Health (Austin, TX)
    …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
    Highmark Health (11/21/25)
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  • Chief Medical Officer

    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...of quality and cost improvement and develops systems to review utilization of resources and objectively measure… more
    HCA Healthcare (11/07/25)
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  • Dental Network Service Representative

    Highmark Health (Austin, TX)
    …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
    Highmark Health (11/14/25)
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  • Psychologist Reviewer

    Centene Corporation (Austin, TX)
    …Team!** Are you a licensed Psychologist with a passion for improving access to behavioral health care? Centene is seeking a **Remote Psychologist** to support ... the Medicaid population. **Position Purpose:** Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical… more
    Centene Corporation (11/28/25)
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  • Pharmacy Product Director - Medicare DSNP

    Highmark Health (Austin, TX)
    …+ 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...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
    Highmark Health (11/14/25)
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  • Director of Clinical Informatics

    HCA Healthcare (Dallas, 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 ... and providing ongoing support for corporate/division/facility projects related to the electronic health record (EHR) including: + standardization + utilization +… more
    HCA Healthcare (10/30/25)
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  • Medical Director-Dermatology Appeals

    Elevance Health (Houston, TX)
    …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
    Elevance Health (12/11/25)
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  • Director Health Systems Sales - CuraScript…

    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...all relevant data is accurate and to organize quarterly review meetings, RFP's or other events. Proactively identify training… more
    The Cigna Group (11/06/25)
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  • Director Care Transition

    Texas Health Resources (Bedford, TX)
    …and vascular care, acute and medical-surgical care, intermediate/step-down care, oncology, behavioral health , and emergency medicine. Additional services include ... and top-notch benefits? We're looking for qualified candidates like you to join our Texas Health family._ + Work location: Texas Health HEB + Core work hours:… more
    Texas Health Resources (12/06/25)
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