- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for ... residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability to work effectively both… more
- Catholic Health Initiatives (Bryan, TX)
- …obtaining pre-certification reference number, approved length of stay, and utilization review company contact person and telephone number 13. Notify hospital Case ... regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre-certification 14. Contact physician's on scheduled… more
- Prime Therapeutics (Austin, TX)
- …and making outbound calls to qualified members across all lines of business to review the benefits of the MTM program. This position speaks with members to gather ... meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid...visa or residency sponsorship **Additional Qualifications** + Has suitable home office (ie, chair, desk, internet, etc.) that meet… more
- Fresenius Medical Center (Fort Worth, TX)
- …logs as directed and applicable + Support patient registration and use of connected health + Provide patient home support as indicated and permissible under ... **PURPOSE** **AND** **SCOPE:** Functions as part of the dialysis health care team in providing safe and effective dialysis therapy for patients under the direct… more
- Evolent (Austin, TX)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Humana (Austin, TX)
- …ensuring best and most appropriate treatment, care or services for members utilizing Home Health and Skilled Nursing Facility services. This team sits in ... the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to...service telephone experience desired + Experience with SNF and/or Home Health + Prior experience with CGX,… more
- Kelsey-Seybold Clinic (Webster, TX)
- …within the palliative care services team to improve quality of life and health for patients with complex chronic illnesses and approaching end-of-life illnesses. + ... Care services to group physicians + Monitor and supervise Supportive Medicine home care delivery team(s) + Facilitate clarification of patient and family goals… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products ... connection with us and enables us to put their Health First. After all, a health services...driving Humana's long-term vision to achieve leading growth in Medicare and individual products. The MarketPoint strategy team was… more
- Molina Healthcare (Austin, TX)
- … Medicare . **PREFERRED EDUCATION:** Master's in Business Administration, Public Health , Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- Gentiva (Lubbock, TX)
- …Group (IDG), as assigned, including presiding over IDG, presentation of patients for review , coordination of minutes, review of patient charts to note and ... new physicians and facilities, durable medical equipment (DME) pickup, Medicare patient eligibility, obtaining authorization and reauthorization as needed,… more
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