- Humana (Austin, TX)
- …and integrated care needs for those with autism + Prior experience with Utilization Review , Utilization Management, Peer Reviews and/or Quality Management ... of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills… more
- Humana (Austin, TX)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Humana's offices for training or meetings may be required. **Work-At- Home Requirements** + Must have the ability to provide… more
- Humana (Austin, TX)
- …of MHK + Previous Medicare/Medicaid Experience + Previous experience in utilization management + Previous claims experience **Work-At- Home Requirements** To ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Austin, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...experience as a Registered Nurse (RN). + Background in home - based care settings, including traditional home… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- Summary The South Texas Veterans Health Care System is currently seeking a Physician ( Home Based Primary Care) to provide high quality patient centered care to ... Veterans for the Home Based Primary Care and Geriatric Primary...the development of the new focus on the Medical Home and Patient Centric Care, Utilization , Quality… more
- CenterWell (Temple, 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
- Molina Healthcare (San Antonio, TX)
- …current active license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. Job Summary Provides… more
- Molina Healthcare (TX)
- …Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high speed required Work Schedule Monday to ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Elara Caring (Irving, TX)
- …Identifies and reports potential payment/coverage problems. + Supervises and coordinates utilization review activities. + Participates in strategic development ... a huge role in the growth of an entire home care industry. Here, each employee has the chance...Key Accounts, including participation in weekly, monthly, and quarterly review meetings, as needed. + Ensures accuracy of all… more