- UTMB Health (Friendswood, TX)
- …trends of inappropriate resource utilization to Director and/or Assistant Director of Utilization Review /Case Management. + Maintains a documentation ... optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge,… more
- Humana (Austin, TX)
- …a part of our caring community and help us put health first** The Dental Director is responsible for providing clinical oversight to promote the oral health of the ... of claims, appeals, and potential quality of care issues. The Dental Director - Texas assists in the design, development, and implementation of appropriate… more
- Elevance Health (Grand Prairie, TX)
- …members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance ... Day to day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Genesis Healthcare (Dallas, TX)
- …Area Director ). 9. Assumes responsibility for daily staffing and utilization with input from treating therapists, consideration of clinical requirements, and ... our Clinicians in Action professional development program. Responsibilities The Director of Rehab PTA is responsible for the efficient... in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area… more
- Humana (Austin, TX)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Molina Healthcare (Austin, TX)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more