- Molina Healthcare (San Antonio, TX)
- …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- Evolent (Austin, TX)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization … more
- BAYADA Home Health Care (Austin, TX)
- …should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding_ ... Review and Coding Manager. The OASIS and Coding Review Manager provides support to all BAYADA Home...+ This role is **fully remote,** candidates may be based anywhere in the US + Base Salary: $… more
- BAYADA Home Health Care (Austin, TX)
- …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, Coder, ... considered, there is no flexibility around this requirement.** BAYADA Home Health Care has an immediate opening for a...immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work… more
- CenterWell (League City, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …centered care to Veterans under the different services such as Community Living Centers, Home Based Primary Care, Hospital In Home , Geriatric Evaluation ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities The Geriatric and...the development of the new focus on the Medical Home and Patient Centric Care, Utilization , Quality… more
- Molina Healthcare (Austin, TX)
- … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Humana (Austin, TX)
- …explain the rationale behind utilization management decisions, + Work includes computer- based review of moderately complex to complex clinical scenarios, ... least 2 years of experience post-training providing clinical services . Experience in utilization management review and case management in a health plan setting… more
- ChenMed (Houston, TX)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management, home health, discharge planning experience ... with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ;...of care/LOS. + Validates Discharge plan for safe transition home , utilization of preferred providers or timely… more
- CommonSpirit Health (Houston, TX)
- …million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital- based locations, in addition to its home - based services and ... position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case… more