- Centene Corporation (Austin, TX)
- …(BCBA) required. Master's degree for behavioral health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Adecco US, Inc. (Dallas, TX)
- …Familiarity with Medicare Part D Star measures (SUPD, SPC, CMR) + Clinical experience in medication review and pharmaceutical/medical vocabulary **Essential ... ** Clinical Pharmacist (Work from Home - Tallahassee, FL)** Pay Rate: $57.43/hr Location: Remote - Tallahassee, FL (must hold an active Florida Pharmacist… more
- Houston Methodist (Houston, TX)
- …and identify and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex ... **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with revenue integrity teams to review provider services and provide effective education and feedback. Coordinates… more
- Sharecare (Austin, TX)
- …supporting each individual through the lens of their personal health and making high- quality care more accessible and affordable for everyone. To learn more, visit ... + Prepare, in collaboration with Director Client Success the QBR and Annual Review **Reporting** + Collaborate with the reporting team to analyze necessary data,… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based on position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service suitability. You'll educate the ... plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify medical records… more
- Molina Healthcare (Houston, TX)
- …are highly preferred. Further details to be discussed during our interview process. Remote position - Home office with internet connectivity of high speed required ... 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
- Banner Health (TX)
- …documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. ... support throughout your career here! This is a fully remote position and available if you live in the...Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation… more
- Houston Methodist (Houston, TX)
- …with established rules and regulatory body guidelines. This position performs data quality review to ensure data integrity, coding accuracy, and revenue ... preservation. Additional duties include participating in quality review and performance improvement projects throughout...that operate at the system level to help enable clinical departments to provide high quality patient… more
- American Heart Association (Dallas, TX)
- … quality programs. + Contribute to the design, development, and testing of clinical quality measures. + Provide strategic and technical expertise related to ... with quality measure development standards, such as Quality Data Model (QDM), Clinical Quality...have a competitive base salary. That's why we regularly review the market value of jobs and make adjustments,… more
- Humana (Austin, TX)
- …team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical … more