- Molina Healthcare (TX)
- …comprehensive waiver enrollment and disenrollment processes. + Develops and implements a case management plan, including a waiver service plan, in collaboration ... care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes...Long Term Services & Supports. + 1-3 years in case management , disease management , managed… more
- Houston Methodist (Houston, TX)
- …and processes. The Regulatory Compliance Specialist position maintains documentation for clinical research studies, case report forms and study and ... regulatory files. Under the direct supervision from the management , this position addresses problem solving issues of moderate...the need arises. **EDUCATION** + Bachelor's degree or higher ** WORK EXPERIENCE** + Two years of clinical … more
- Houston Methodist (Houston, TX)
- …an accredited school of nursing ** WORK EXPERIENCE** + Five years hospital clinical nursing, case management and/or home health experience + Experience ... **Notes -** + **Selected candidate will work remote after completing onsite department training.** +...healthcare team to provide professional nursing care and disease management to various population groups identified in the hospital… more
- Sedgwick (Irving, TX)
- …the claimant's physician and employer. + Refers cases as appropriate to team lead and clinical case management to assist with claim determination. + Meets ... mental, physical, financial and professional needs. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical… more
- Molina Healthcare (San Antonio, TX)
- …Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management , Certified Professional ... role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6...or modification of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical… more
- Veterans Affairs, Veterans Health Administration (Dallas, TX)
- …instruments to assist with diagnostic assessment. Experience providing crisis intervention and case management services References: VA Handbook 5005 Part II ... Highly Qualified Individual. The Organizational Location of the Position is: PTSD Clinical Team, Mental Health Service, VA North Texas Health Care System (VANTHCS),… more
- CVS Health (Austin, TX)
- …members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business ... of health care resources. **This is a remote based ( work at home) based anywhere in the US.** Aetna,...direction in support of medical management programs through participation in clinical team… more
- Catholic Health Initiatives (Houston, TX)
- …degree **_Preferred:_** + BSN degree + 3-5 years relevant experience + Case Management experience **Required Licensure and Certifications** + Texas RN:TX ... related to that team. + Implements specific program goals including high priority case management redesign efforts required to improve performance. + Works… more
- US Tech Solutions (San Antonio, TX)
- **Position Summary:** The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization ... for specialty medications. The clinical pharmacist will apply clinical knowledge to...service level agreements. (20%) 2. Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare… more
- Houston Methodist (Houston, TX)
- …basis, which can include updating reporting and/or participating in regular meetings with case management and finance for in-house patients to ensure timely ... complex financial counseling functions (eg, extended payment arrangements, discounts, single case agreements, case rates, etc.). **PEOPLE ESSENTIAL FUNCTIONS** +… more