- CVS Health (Austin, TX)
- …Health Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM (Utilization Management) experience *Active and current state ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care...As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes… more
- CenterWell (Austin, TX)
- …inquiries in accordance with organizational policies and regulatory guidelines. The UM Administration Coordinator 2 provides non- clinical support for the ... Utilization Review and/or Prior Authorization, preferably within a managed care organization **Additional Information** Travel: While this is a remote position,… more
- Evolent (Austin, TX)
- … expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** ... Process improvement and enhancement of **provider engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited… 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, ... and action plan, which includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate care at the most… 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 ... *Two (2) or more years of experience in Health Care Delivery System eg, Clinical Practice and...ABMS or AOA recognized specialty including post-graduate direct patient care experience. **Preferred Qualifications:** Previous UM experience… more
- Evolent (Austin, TX)
- …(FDA), and various prior authorization lists, facilitating timely decision-making for clinical and business review teams. + Demonstrate strong analytical ... in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care , or healthcare consulting environment. +… 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
- MTC (Anson, TX)
- …Bluebonnet Detention Center in Anson, Texas, where we're looking for a dedicated health care provider to bring compassionate care to a correctional setting where ... to the detainee population in a timely fashion. Render medical judgment regarding care provided to detainees assigned to the facility in compliance with MTC Medical… more
- MTC (Raymondville, TX)
- …to the detainee population in a timely fashion. Renders medical judgment regarding care provided to detainees assigned to the facility in compliance with MTC Medical ... and customer directives, along with the Community Standards of Care . **Essential Functions:** 1. Perform complete medical histories and physical examinations; form … more
- Evolent (Austin, TX)
- …You Will Be Doing:** + Responsible for oversight of utilization management ( UM )/ care management (CM) correspondence development, internal and external approvals, ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...and on-going maintenance of corporate clinical correspondence to ensure compliance with legislative and accreditation… more