- Highmark Health (Austin, TX)
- …Proven ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... Management Knowledge: A strong understanding of utilization management principles, processes, and industry best practices. + Clinical Knowledge: Familiarity… more
- Elevance Health (Grand Prairie, TX)
- …is granted as required by law._ This role's primary focus is ABA utilization management The ** Manager Behavioral Health Services** is responsible ... for Behavioral Health Utilization Management (BH UM). **How you will...or federal requirements that may apply; provided that the manager 's director has one of the types of licensures… more
- Houston Methodist (The Woodlands, TX)
- …eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and managed ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a...determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan… more
- Houston Methodist (Sugar Land, TX)
- …Provides education to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of department scores for ... prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as...state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance… more
- Molina Healthcare (Fort Worth, TX)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Grifols Shared Services North America, Inc (Dallas, TX)
- …specified "Account List" of Health Systems designed to increase the adoption and utilization of the Grifols Bleeding Management product portfolio. The KAM's ... countries and regions. **Role and Responsibilities of a Bleeding Management KAM** **About the Role:** The KAM will play...provide any necessary support to the responsible National Account Manager (NAM) in the execution of the contracting process… more
- HCA Healthcare (Frisco, TX)
- …of care in 21 states and the United Kingdom. We are looking for a Nurse Manager of Case Management for our Medical City Frisco team where excellence creates ... be an influencer in healthcare? **Apply for our Nurse Manager of Case Management role today!** **Job...projects. + Works cooperatively with physicians to achieve the utilization of the case management plan. +… more
- HCA Healthcare (El Paso, TX)
- …Come build your career with us! **Job Summary and Qualifications** The Case Management Manager works in conjunction with other members of the interdisciplinary ... **Description** **Introduction** We are seeking a(an) RN Manager Case Management with Del Sol...as needed + You will complete accurate and timely utilization review of patient charts to insure appropriate … more
- CVS Health (Austin, TX)
- …with heart, each and every day. We are seeking a proactive and highly organized Manager of Production Management to join the Signify Health team to oversee field ... based on service territory and capacity constraints + System Utilization & Workflow Management + Operate and maintain Salesforce Field Service to manage… more
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