- Houston Methodist (Baytown, TX)
- …for an expanded clinical role that may include responsibility for proactive review of patient profiles, participation in basic clinical functions such as ... areas of the department to include processing orders, therapy review , and education to patients and other members of...a unit-based pharmacist and exercises good judgment in patient care decisions by providing operational and clinical … more
- Evolent (Austin, TX)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a...you ready to make a meaningful impact on patient care in a non- clinical setting? Join our… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …has as its focus on the following: prevention; health promotion, psychoeducation, care coordination, direct clinical services, and chronic disease case ... Summary The Patient Aligned Care Team (PACT) is part of a comprehensive...evaluate his/her own practice through participation in professional peer review case conferences, research studies, or other organized means.… more
- HCA Healthcare (Dallas, TX)
- …with a performance excellence, outcomes-focused mindset. + Provides leadership to drive care coordination for clinical improvement and service enhancement + ... degree preferred. EXPERIENCE: + Minimum 3 years of related clinical and management experience involving care coordination,...encourage you to apply for our Regional Director of Care Coordination RN opening. We promptly review … more
- Kelsey-Seybold Clinic (Webster, TX)
- …development of clinical practice guidelines/standards in support of quality palliative care + Timely review , oversight, and documentation of patient care ... **Job Summary:** + Provides clinical expertise within the palliative care services team to improve quality of life and health for patients with complex chronic… more
- CenterWell (Austin, TX)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience +… more
- CenterWell (Austin, TX)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management… more
- Actalent (Dallas, TX)
- Clinical Review Nurse (Utilization Management)100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent reviews, ... + Perform concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate medical necessity. + Contribute to… more
- CVS Health (Austin, TX)
- …self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...as experience with transferring patients to lower levels of care . + 1+ years' experience in Utilization Review… more
- CVS Health (Austin, TX)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a ... to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical ...* 2 or more years of experience in Health Care Delivery System eg, Clinical Practice and… more