- Elevance Health (Grand Prairie, TX)
- …as a resource and consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be required to represent the company to ... May chair company committees. + Interprets medical policies and clinical guidelines. + May develop and propose new medical...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Houston Methodist (Houston, TX)
- …team and clinical staff when coding related, and medical necessity appeals are warranted. **FINANCE ESSENTIAL FUNCTIONS** + Manage multiple work queues for ... outside Houston Metropolitan area No **Company Profile:** Known for its clinical excellence, compassionate care and world-class physicians, Houston Methodist… more
- Evolent (Austin, TX)
- …engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited appeals ,** ensuring compliance with UM ... We Offer:** + A unique opportunity to **impact patient care beyond direct clinical practice.** + A...+ **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or disciplinary… more
- Prime Therapeutics (Austin, TX)
- …for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....+ Experience in managed care , specialty drugs, care management and utilization review . + Meets… 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 ... Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination...*Two (2) or more years of experience in Health Care Delivery System eg, Clinical Practice and… more
- Humana (Austin, TX)
- …**Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Elevance Health (Grand Prairie, TX)
- …focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve._ The ** Clinical Operations Associate Medical ... years of clinical experience post residency. Preferably in inpatient post-acute care + Board certified in Physical Medicine and Rehab is preferred. For… more
- CVS Health (Austin, TX)
- …holiday coverage. **Required Qualifications:** - Five or more years of experience in Health Care Delivery System eg, Clinical Practice and Health Care ... a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience -Electronic medical systems/record experience -Managed Care … more
- Houston Methodist (Katy, TX)
- …variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care . Houston Methodist is an ... to: medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This… more
- Houston Methodist (Houston, TX)
- …and associated audits by the fiscal inter-mediatry. Also directs re-opening requests and appeals . + Directs the coordination, review and filing of state 1115 ... variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care . Houston Methodist is an… more