- Evolent (Austin, TX)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...Director, MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. you will be a… more
- Houston Methodist (Sugar Land, TX)
- …responsible for performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration ... care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical...cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or… more
- Humana (Austin, TX)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient… more
- Evolent (Austin, TX)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Austin, TX)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Austin, TX)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… 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 ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals .… more
- Option Care Health (Austin, TX)
- …patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining ... patients with an alternative to hospital infusion therapy. With more than 2,900 clinical experts, Option Care Health is able to provide high-quality infusion… more
- Molina Healthcare (Austin, TX)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS, ... includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate ...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more
- Centene Corporation (Austin, TX)
- … care management teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants ... Assists in the development and implementation of physician education with respect to clinical issues and policies. + Identifies utilization review studies and… more