- Molina Healthcare (Houston, TX)
- …Qualifications * Experience with utilization /quality program management. * Managed care experience. * Peer review experience. * Certified Professional in ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health...Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager … more
- KBR (Houston, TX)
- …current with the provision of care . + Provide input for the development and utilization of required databases. + Conduct peer (record) review s for the HP ... . We maintain a highly qualified workforce to help care for service people and astronauts across the world...POTFF Staff, and as directed by local HP program manager and/or coordinator. + Document work performed, utilization… more
- HCA Healthcare (Houston, TX)
- …team. Grow your career with an organization committed to delivering respectful, compassionate care , and where the unique and intrinsic worth of each individual is ... auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling… more
- HCA Healthcare (Dallas, TX)
- …staff committees as necessary. + Assists with staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician ... team. Grow your career with an organization committed to delivering respectful, compassionate care , and where the unique and intrinsic worth of each individual is… more
- Elevance Health (Houston, TX)
- …is a benefit-management leader in Illinois. Our platform delivers significant cost-of- care savings across an expanding set of clinical domains, including radiology, ... Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners… more
- CenterWell (Fort Worth, TX)
- …in patient experience, quality of care , clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... and social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization *Monitor and manage daily patient care and initiatives to… more
- CenterWell (Arlington, TX)
- …in patient experience, quality of care , clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to align with… more
- Elevance Health (Grand Prairie, 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 ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more
- Select Medical (Fort Worth, TX)
- …the staff in the use of the nursing process and in the development and utilization of the interdisciplinary care plan for all patients. Assesses and makes ... nursing staff work loads. + Collaborates with the Chief Nursing Officer/Nurse Manager /House Supervisor to ensure continuity of care over twenty-four hours.… more
- Baylor Scott & White Health (Temple, TX)
- … and pharmacy benefit management. This includes prescription drugs, benefits design, utilization review , formulary management, and cost containment strategies. + ... (BSWH). This includes selecting and managing the outsourced Pharmacy Benefit Manager (PBM). They also handle the purchase, storage, compounding, packaging, and… more
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