- Evolent (Austin, TX)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with… more
- Molina Healthcare (San Antonio, TX)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management activities aimed at providing… more
- HCA Healthcare (Plano, TX)
- …for our team to ensure that we continue to provide all patients with high quality , efficient care. Did you get into our industry for these reasons? We are an ... policies and procedures, supervision and training of staff, inventory management, quality assurance and regulatory compliance. **What qualifications you will need:**… more
- CVS Health (Austin, TX)
- …using React Native and TypeScript for our clinical applications + **Code Review & Quality Assurance** : Conduct thorough code reviews and maintain high ... with product managers, designers, and other engineering teams to deliver high- quality solutions + **Technical Documentation** : Create and maintain technical… more
- Evolent (Austin, TX)
- …Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Provides clinical rationale for standard ... the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management, you will...within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Molina Healthcare (Dallas, TX)
- …or master's degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** ... HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more
- Texas Health Resources (Dallas, TX)
- ** Clinical Outcomes Coordinator, Registered Nurse** **_Bring your passion to Texas Health so we are Better + Together_** **Work location:** Texas Health Dallas, 8200 ... with care transitions team to facilitate discharges, RCB measures, review of excess days and patient throughput . Facilitates...well as several other benefits. . Delivery of high quality of patient care through nursing education, nursing research… more
- Sedgwick (Austin, TX)
- … service and client satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients ... clinical operations for more than 3 assigned teams/offices; develops and implements clinical objectives and initiatives. + Ensures quality training of new and… more
- Evolent (Austin, TX)
- …Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... Director, MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. you will be a...Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as… more
- Methodist Health System (Dallas, TX)
- …and for professional growth and development. * Utilizes the nursing process to ensure quality patient care is provided throughout the episode of care. * Other duties ... organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been… more