- Highmark Health (Austin, TX)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create...**Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management … more
- Molina Healthcare (Austin, TX)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- HCA Healthcare (Houston, TX)
- …want your knowledge and expertise! **Job Summary and Qualifications** The Manager of Clinical Informatics facilitates high quality, patient-centered care through ... implanting and providing ongoing support for corporate/division/facility-wide standardization, utilization , integration, and optimization activities related to the electronic… more
- HCA Healthcare (Dallas, TX)
- …staff committees as necessary. + Assists with staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician ... participates in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement improvements… more
- CenterWell (Corpus Christi, TX)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- HCA Healthcare (Houston, TX)
- …Summary and Qualifications** Under the general supervision of the Pre-Admit Manager , performs support services for the department, assigned clerical, secretarial, ... and related responsibilities, promoting communication between the Director, Manager , medical staff, hospital staff, and patients. Provides effective scheduling by … more
- Ryder System (Austin, TX)
- …or if the Claim Manager is not available. Participates with Claim Manager in the selection and management of outside vendors for investigation, cost ... _Job Seekers can review the Job Applicant Privacy Policy by clicking...retained for investigations, cost containment, expert witnesses, and litigation management to ensure claims are being handled properly according… more
- Elevance Health (Grand Prairie, TX)
- …including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an impact:** + ... drug monographs, and formulary recommendations. + Develop strategies to drive formulary utilization and optimization. + Collaborate with account management teams… more
- Elevance Health (Houston, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience.… more
- NexTec Group (TX)
- …(Key Outcomes): + Complete assigned tasks independently and may collaborate with project manager to assign tasks to others according to team members' skill sets and ... within alignment of the Statement of Work, Business Process Review (BPR) documentation, and NexTec methodology. + Maintain at...and NexTec methodology. + Maintain at least 75 percent utilization on an average annual basis. + Maintain Acumatica… more