- Humana (Austin, TX)
- …+ Excellent written and communication skills + 5 years of established, post-residency clinical experience + Knowledge of the managed care industry including ... first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on… more
- AdventHealth (Killeen, TX)
- …service of selected patient populations across the continuum of illness; promotes effective utilization of and monitors health care resources; and provides input ... in the heart of Texas, AdventHealth Central Texas provides care for the citizens of Bell, Coryell and Lampasas...interdisciplinary team via the Charge Nurse to achieve optimal clinical and resource outcomes. The Staff RN will adhere… more
- AdventHealth (Burleson, TX)
- …service of selected patient populations across the continuum of illness; promotes effective utilization of and monitors health care resources; and provides input ... 76028 **The community you'll be caring for:** + Our care for patients extend to the spiritual level by...departments including "Great Place to Work" by Becker's Hospital Review and Gallup. + Work with the latest technology… more
- Actalent (Houston, TX)
- …Pharmacist : Job Description: Your main role will be utilizing your clinical skills to complete utilization management reviews (Prior authorizations, Coverage ... Two (2) years of work experience in retail, managed care , or clinical pharmacy + Doctor of...opportunity after peak season to complete training for and review specialized cases (ex: oncology, hepatitis C, and other… more
- Houston Methodist (Houston, 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 ... and maintain the financial model in Excel. This position will also help review financial projections and assumptions associated with new capital projects and capital… more
- Houston Methodist (Houston, 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 ... many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance,… more
- Prime Therapeutics (Austin, TX)
- …compliance with reporting and participation requirements; collaborate with Specialty Clinical Program Directors to identify potential performance gaps; work with ... to update contract documents including agreements and applications for utilization in contracting/re-contracting activities based on new network participation… more
- Houston Methodist (Houston, TX)
- …position serves to support staff in ensuring the delivery of exceptional patient care and adherence to standards of practice for optimal patient safety, quality ... many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance,… more
- Houston Methodist (The Woodlands, TX)
- …in practice: evidence-based practice, the conduct of research, research utilization , and research dissemination. Collaborates and develops innovative programs to ... nursing interventions for improvement. Supports hospital efforts to improve quality care , linking research to improved patient outcomes. + Plans, directs, and… more
- Guidehouse (Lewisville, TX)
- …receivable follow-up, timely filing guidelines and the ability to effectively review remittance advices and electronic billing reports from payer to determine ... account resolution + Submits appeals, as appropriate, for all non- clinical denials + Monitors all denials for trends and...PC skills in a Windows environment. + Knowledge and utilization of desktop applications to include Word and Excel.… more