- Humana (Austin, TX)
- …with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received by members of the Medicare ... with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and… more
- Providence (Plainview, TX)
- …Health Information Management degree. + Experience with health plans, project management , data analysis, and/or case review. **Why Join Providence?** Our ... Coding Quality Auditor, HEDIS who will:** + Be responsible for conducting clinical quality audits/overreads for the Quality Department + Identify and reports issues… more
- HCA Healthcare (Houston, TX)
- …or work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at The Woman's Hospital ... coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a… more
- Molina Healthcare (Tyler, TX)
- …their homes, completing assessments needed for determining the types of services and resources we need to provide as part of your responsibilities. Preference will ... Teams, and One Note. Job Summary Provides support for care management /care coordination long-term services and supports specific activities and collaborates with… more
- Elevance Health (Grand Prairie, TX)
- …care management process through reviewing member profiles, recommending members for lock-in, case management or disease management . + Respond to and ... a year-long project targeted at improving member care through proper medication management . + Perform weekly clinical prior authorizations and coverage… more
- HCA Healthcare (Dallas, TX)
- …or work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Medical City Dallas! ... coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …guidelines. + Individual casework practice, crisis intervention, information and referral, case management and interviewing. + Experience working with ... telemedicine. + Responds to initial assessment inquiry and coordinates care with clinical support team as needed. + Coordinates with school counselor, admin, child,… more
- ASM Research, An Accenture Federal Services Company (Austin, TX)
- …to meet call center target metrics + Ensures complete and accurate documentation in case management system (CMS) + Assists direct reports to deescalate callers, ... and procedures + Facilitates and participates in staff training + Participates in staff meetings and clinical conferences + Supports quality and risk management … more
- ChenMed (Houston, TX)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required that ... and others including case managers, acute and transitional-care physicians, and other resources that may be available depending on the market. + PCP will have an… more
- Surgery Care Affiliates (Rockwall, TX)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... high level of patient care, evaluating other nurses and acting as an educational resource for nurses. Key Responsibilities: + Charge nurse is required to be an… more