- Elevance Health (Grand Prairie, TX)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Texas Health Resources (Arlington, TX)
- …effective utilization and adherence to best practices. 10% Data Management : Maintain accurate and up-to-date contract records in the Icertis system. Ensure ... Contract Support Specialist - Contract Life Cycle Management _Bring your passion to Texas Health so...Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager 's discretion) Department Highlights: + Remote Position + Gain… more
- Burns & McDonnell (Houston, TX)
- …to meet program management , global practice, and regional objectives. + Regularly review team utilization of staff to make sure employees have a clear ... proud to be the market leader in providing program management services to the electric & gas utility industry....Hiring & Onboarding + Work with the SCR GP Manager and HR Recruiting team to proactively recruit the… more
- Sharecare (Austin, TX)
- …change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is ... disease management program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- CenterWell (Arlington, TX)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... care team, combining clinical practice experience with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- Molina Healthcare (Houston, TX)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... and clinical leadership for health plan and/or market specific utilization management and care management ...Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of… more
- Guardian Life (Plano, TX)
- …as needed (eg Specialty Referral Guidelines) with guidance from the Quality and Utilization Management Manager . + Demonstrate expertise in QMP processes ... product and to assume responsibility for the functions of utilization management and utilization review , as requested by the Dental Director, Clinical … more
- Molina Healthcare (Fort Worth, TX)
- …including care management , care coordination, transitions of care, utilization management (prior-authorization, inpatient review ), behavioral health, ... professionals, in some or all of the following functions: utilization management , care management , care...and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… more
- Elevance Health (Houston, TX)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually… more
- CenterWell (Austin, TX)
- …of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care received by members in an assigned region, ... practice management . + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid, or… more
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