- Humana (Austin, TX)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Houston Methodist (Sugar Land, TX)
- …determinations and, denial reason and trending as appropriate, Monitors CMS, managed care and payor communications for updates/alerts/releases and functions ... knowledge of Federal, State, and local billing regulations and partners with managed care contracting as needed. + Maintains knowledge of contracts, payor plans… more
- Molina Healthcare (Austin, TX)
- …* 2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare ... discuss and resolve issues related to utilization management, pharmacy, quality of care , and correct coding. * Independently delivers training and presentations to… more
- Methodist Health System (Dallas, TX)
- …is multifaceted; it requires excellent interpersonal and communication skills, knowledge of managed care /health plans, and an understanding of the health ... Word, Excel, and PowerPoint. * Work Experience: 1-5 years' experience in managed care or related field preferred. Marketing experience is a plus. Job… more
- Humana (Austin, TX)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an… more
- CenterWell (Austin, TX)
- …The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care , PBM, market and regulatory insights to develop, and/or ... the Medicaid lines of business. + Utilizes broad understanding of pharmacy, managed care , PBM, market and regulatory insights to support the development of… more
- UTMB Health (Richmond, TX)
- … Care Management UTMB Health Requisition # 2504302 The mission of Correctional Managed Care is to address the healthcare needs of underserved patient ... for health services in compliance with ACA standards and UTMB Correctional Managed Care systems policies and departmental procedures. **_ESSENTIAL JOB… more
- J&J Family of Companies (Dallas, TX)
- …to address critical access and affordability issues for patients. + Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). + Execute business in accordance with the highest ethical,… more
- J&J Family of Companies (Dallas, TX)
- …to address critical access and affordability issues for patients. . Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). . Execute business in accordance with the highest ethical,… more
- Houston Methodist (Katy, TX)
- …competency and professional pathway progression. + Communicates updates/changes to processes, managed care information, throughput, etc., in a timely manner. ... projects after ongoing revenue cycle analysis. Meets with payors and/or Managed Care to discuss aged accounts, adjudications timeframes, and erroneous denials. +… more