- Baylor Scott & White Health (Dallas, TX)
- …or related field preferred. Master's degree preferred. 2. 5+ years of experience in case management, social work, utilization review , or related field. 3. ... function of Baylor Scott and White Health (BSWH), which may include case management, social services, coordination of patient care, patient access, utilization… more
- CenterWell (Austin, TX)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Molina Healthcare (Fort Worth, TX)
- …must be active and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional ... teams including care management, care coordination, transitions of care, utilization management (prior-authorization, inpatient review ), behavioral health,… more
- Molina Healthcare (Austin, TX)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… more
- HCA Healthcare (Houston, TX)
- …Summary and Qualifications** Under the general supervision of the Pre-Admit Manager , performs support services for the department, assigned clerical, secretarial, ... and related responsibilities, promoting communication between the Director, Manager , medical staff, hospital staff, and patients. Provides effective scheduling by… more
- 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 ... for clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- HCA Healthcare (Houston, TX)
- …to protocol requirements/compliance + Ensures the integrity of the data submitted on Case Report Forms or other data collection tools by careful source document ... review ; monitors data for missing or implausible data +...+ Collects, completes, and enters data into study specific case report forms or electronic data capture systems +… more
- CenterWell (Corpus Christi, TX)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... coaching initiatives are precise *Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving clinical excellence… more
- Elevance Health (Grand Prairie, TX)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an ... the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review , drug monographs, and formulary recommendations. + Develop strategies to… more
- Veterans Affairs, Veterans Health Administration (Harlingen, TX)
- …works with the Veteran Transportation Service (VTS) Supervisory Mobility Manager for transportation workload forecasting, scheduling design, procedure development, ... of support services eg, systems management, operations, workload forecasting, review , and reporting of data/statistical results of program/project studies, vehicle… more