- 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
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC -...measures to achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… 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 ... care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical management review...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
- Humana (Austin, TX)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team… 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