- Houston Methodist (Houston, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. Reviews level of care ... effectively. Proactively takes action to achieve continuous improvement and expedite care /facilitate discharge. + Performs post-discharge review by analyzing the… more
- Catholic Health Initiatives (Houston, TX)
- …Market President, Region Chief Medical Officer, and Region Chief Nursing Officer to lead clinical care delivery in the market. The Houston market comprises eight ... resulting in ownership and accountability that results in rapid implementation of clinical best practices, reduces unnecessary care variation, and drives… more
- Veterans Affairs, Veterans Health Administration (Corpus Christi, TX)
- …Care Mental Health Integration (PCMHI) Program; supervising PCMHI, Home-Based Primary Care (HBPC) staff and other health-focused clinical positions; and, ... overseeing PCMHI Program services for the VA Texas Valley Coastal Bend Health Care System (VATVCBHCS). The PCMHI Program includes clinical and non- clinical… more
- Healthfirst (TX)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge ... 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
- Houston Methodist (The Woodlands, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. Reviews level of care ... for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and… 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
- Houston Methodist (Cypress, TX)
- …decision support, safe medication delivery, and other devices in the delivery of clinical care . **FINANCE ESSENTIAL FUNCTIONS** + Develops and manages department ... review appropriate data relating to operations, quality of care , and patient safety, and quality of customer service....Quality and Patient Safety strategy that links delivery of clinical care with education and research, adopting… more
- YesCare Corp (Waxahachie, TX)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. **YesCare Benefits** (only ... staff. + Ensure and provide on-call services. + Annually review and approve clinical protocols, policies and...proper technique for basic cardiopulmonary resuscitation and AED use. ** Clinical ** + Provides typical community standard care … more
- Humana (Austin, TX)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... MD or DO degree + 5+ years of direct clinical patient care experience post residency or...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Houston Methodist (The Woodlands, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. + Participates in denial ... planning, utilization management, case management, performance improvement and managed care reimbursement + Understanding of pre-acute and post-acute venues of … more