- Evolent (Austin, TX)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet...patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care… more
- Catholic Health Initiatives (Houston, TX)
- …to maintain effective team leadership and oversight. This role supports the UM Director in ensuring efficient operations with all processes, policies, ... **Responsibilities** The Utilization Management ( UM ) Manager is responsible...stay reviews, retrospective authorizations utilizing standardized criteria to determine medical necessity; reviews and processes concurrent denials that require… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
- Molina Healthcare (Austin, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process… more
- Molina Healthcare (San Antonio, TX)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease… more
- CVS Health (Austin, TX)
- …System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current state medical license without ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… more
- Houston Methodist (Sugar Land, TX)
- …overtime percentage, and other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, ... to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and… more
- Centene Corporation (Austin, TX)
- …practice models and utilization management processes + Interact with the Medical Director , or designee, to discuss clinical authorization questions and ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...the Central Time Zone + TX licensure required + Utilization Management ( UM ) experience strongly preferred Pay… more
- MTC (Anson, TX)
- …to the health services administrator, and clinically to the MTC Corporate Medical Director . Responsible for providing medical services related ... Full time, Monday - Friday, day schedule** **Benefit package includes:** + ** Medical , Vision, Dental, and Prescription Drug Benefits** + **Life, Accidental Death and… more