- HCA Healthcare (Austin, TX)
- …and retrospective review of patient medical records for purposes of utilization review , care coordination compliance with requirements of external review ... will need:** **EXPERIENCE REQUIRED** + **2 - 5 years Case Management Experience within the last year**... Manager Austin Market Float Pool PRN opening. We review all applications. Qualified candidates will be contacted by… more
- Evolent (Austin, TX)
- …reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews ... Therapy you will be a key member of the utilization management team. We can offer you...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Molina Healthcare (San Antonio, TX)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- BAYADA Home Health Care (Austin, TX)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to maintain ... + Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health… more
- Molina Healthcare (TX)
- …of stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services ... and guidelines for BHT service delivery. * Works collaboratively with the Case Management department to ensure members receive appropriate and timely… more
- CommonSpirit Health (Houston, TX)
- …and efficient utilization of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make ... Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic/electronic… more
- Catholic Health Initiatives (College Station, TX)
- …Nurse (RN)** + **Must have have a minimum of Five (5) years experience in Case Management or Care Coordination.** Responsible for the daily oversight of the ... for designated units related to the activities assigned to Case Management staff including daily team operations,...Management a. Serves as a clinical resource for utilization management , compliance for the rules and… more
- Houston Methodist (Houston, TX)
- …could include physician's office, acute care, long term care, home health. + Case Management experience preferred. **LICENSES AND CERTIFICATIONS - REQUIRED** + ... management support to the department staff to facilitate efficient utilization of resources including referrals management , communication and collaboration… more
- CenterWell (Longview, TX)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...of care analysis to determine efficiency, the efficacy of case management system as well as any… more
- Evolent (Austin, TX)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more