- CommonSpirit Health (Houston, TX)
- …Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case management staff and/or other health care ... requirements and, in accordance with the hospital's objectives for providing quality patient care , to assure effective and efficient utilization of health … more
- Houston Methodist (Houston, TX)
- …Medicaid, and managed care reimbursement methodologies** + **Ability to review clinical documentation for Medical Necessity and payer requirements** + ... 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… more
- Molina Healthcare (Austin, TX)
- …adjustment, disease management, and evidence-based guidelines. + Experience in Utilization /Quality Program management + HMO/Managed care experience **PREFERRED ... 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,… more
- Centene Corporation (Austin, TX)
- …physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of ... management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality… more
- HCA Healthcare (Live Oak, TX)
- …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more
- CVS Health (Austin, TX)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... every day. **Position Summary** Help us elevate our member care to a whole new level! Join our Aetna...serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our… more
- Houston Methodist (Houston, TX)
- …results, special visits, PCP visits, dieticians, diabetes educators, etc. Ensures patient utilization and activation of MyChart. + Provides care coordination ... for assigned patient populations, for providing high quality support of patient care and services. This position oversees appropriate scope of practice (ie Hand… more
- Baylor Scott & White Health (Dallas, TX)
- … access and capacity and works to improve wait times. 3. Reduces ED utilization as appropriate through proactive management of clinical acumen and ED escalation ... review activities. 8. Evaluates new developments in medical care and recommends new practices and procedures. 9. Ensure...Our central most location will serve as the primary clinical base. As a health care system… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- … care . Responsibilities Staff Physician (SCI/D) is responsible for patient care , patient/family education. Participation in clinical research is optional. ... Spinal Cord Injury/Disorders Service (SCI/D) is responsible for patient care , patient/family education, and supervision of resident physicians. Primarily evaluates… more
- Intermountain Health (Austin, TX)
- …documents patients and/or patient's family, caregivers, and/or legal representatives socio-economic review and screening to support coordination of care . Plans ... patients navigate the complex health system and that help reduce/remove barriers to care . Responsible for clinical support and coordination related to value… more