- HCA Healthcare (Houston, TX)
- …for patient care . Apply today for our Registered Nurse Case Manager opportunity. **Job Summary and Qualifications** Under the direction of the Case Management ... ancillary staff on individual nursing units to promote ongoing review of patient care activities related to... activities related to provision of services, patterns of care , and utilization of resources. + Assists… more
- Molina Healthcare (San Antonio, TX)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... and appropriate/accurate billing and claims processing. + Identifies and reports quality of care issues. + Assists with Complex Claim review including DRG… more
- CenterWell (Longview, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... community and help us put health first** The **Clinical Manager ** coordinates and oversees all direct care ...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Houston Methodist (The Woodlands, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. Reviews level of care ... for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and… more
- Houston Methodist (Cypress, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. Reviews level of care ... effectively. Proactively takes action to achieve continuous improvement and expedite care /facilitate discharge. + Performs post-discharge review by analyzing the… more
- Healthfirst (TX)
- The Case Manager , Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge ... planning, and case management as assigned. The Case Manager , Utilization Management is also responsible for...care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of… more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... for life - and empowers their passion for patient care . Apply today for our RN Case Manager...approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay… more
- AdventHealth (Burleson, TX)
- …completes Talent Care accordingly. + Assist with overseeing clinical teams to review utilization and options for product selection. + Assist Director with ... or North Carolina **The role you'll contribute:** The Senior Clinical Resource Manager reports to the Director of Strategic Clinical Resource Management and Value… more
- CVS Health (Arlington, TX)
- …+ Field Experience. + Bilingual. + Crisis intervention skills preferred. + Managed care / utilization review experience preferred. + Case management and ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Parsons Corporation (San Antonio, TX)
- …on workflow efficiency, and maintaining research documents. Additionally, the Program Manager II will assist with space utilization , financial tracking, ... got what you're looking for. **Job Description:** Parsons is seeking a **Program Manager II** to support Naval Medical Research Unit - San Antonio (NAMRU-SA) and… more