- Houston Methodist (The Woodlands, TX)
- …Services position is responsible for providing and assuring quality pharmaceutical care in accordance with accepted ethical and professional practices and all ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Prime Therapeutics (Austin, TX)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** Innovative… more
- BrightSpring Health Services (San Antonio, TX)
- Our Company SpringHealth Behavioral Health and Integrated Care Overview Behavior Clinic Supervisor for Youth ABA Line of Business MUST BE A FULLY LICENSED BCBA IN ... Assessment, evaluation, training and education, program planning, support services and clinical services to consumers, families and staff. + Provides behavioral… more
- Prime Therapeutics (Austin, TX)
- …implementation of innovative drug solutions, including optimizing optimize drug utilization , patient outcomes, and cost-effectiveness through value-based care ... drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job Description** The… more
- Molina Healthcare (TX)
- …to synthesize complex information. **PREFERRED QUALIFICATIONS:** + **5+ years Clinical Nursing experience, including hospital acute care /medical experience ... claims data to ensure appropriate payment levels, optimize resource utilization , and maintain compliance with state and federal laws....focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject… more
- Houston Methodist (The Woodlands, TX)
- …state, federal, and CMS regulations, DNV requirements, and guidelines on case management, utilization review , and clinical documentation. + Provide ongoing ... resources. This position is a key member and leader of the hospital's utilization review /management committee, which is charged with regulatory goals of ensuring… more
- Humana (Austin, TX)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical ...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Sedgwick (Austin, TX)
- …related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and… more
- Houston Methodist (Sugar Land, TX)
- …Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals ... clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role +… more
- UTMB Health (Friendswood, TX)
- …cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, expertise, approved ... /Case Management program. + Maintains a mechanism for the review of quality of care issues arising...specialty area and/or general nursing. + Provides assistance with clinical issues for non-nursing Utilization Review… more