- Healthfirst (TX)
- …coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge planning, and case management as assigned. The ... Monitors assigned case load to meet performance metric requirements + Functions as a clinical resource for the multi-disciplinary care team in order to maximize… more
- AdventHealth (Burleson, TX)
- …Process Improvement and Patient Safety (PIPS) Program which include patient care coordination, improvement of clinical process through active participation ... participates in quality improvement initiatives and processes. Actively participates in concurrent process improvement and evaluation of trauma care from… more
- Sedgwick (Irving, TX)
- Taking care of people is at the heart of...and employer. + Refers cases to team lead and clinical case management for additional review when ... everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having… more
- UTMB Health (Friendswood, TX)
- …Management program. + Maintains a mechanism for the review of quality of care issues arising during concurrent review , and identifies areas of potential ... quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, expertise,… more
- Molina Healthcare (Austin, TX)
- …authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate ... local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states:...includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate … 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
- San Antonio Behavioral Health (San Antonio, TX)
- …appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with patients' treatment. Reviews treatment plans and status ... The Utilization Review Coordinator conducts utilization reviews to determine if...medical records to assess the appropriateness and quality of care provided. * Verify the accuracy and completeness of… more
- HCA Healthcare (Tomball, TX)
- **Description** **Introduction** Are you looking for a place to deliver excellent care patients deserve? At HCA Houston Healthcare Tomball we support our colleagues ... auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling… more
- Molina Healthcare (San Antonio, TX)
- …expertise in the performance of prior authorization, inpatient concurrent review , discharge planning, case management and interdisciplinary care team ... + Develops medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in...+ 10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/Managed Care … more
- Catholic Health Initiatives (The Woodlands, TX)
- …the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the US & from clinics and hospitals to home-based care ... of clinic management in regards to the business operations of each clinical practice. 1. Manages BSLMG multi-specialty clinic operations. 2. Assists Director of… more