- Humana (Austin, TX)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… more
- Humana (Austin, TX)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management… more
- CVS Health (TX)
- …that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from Home" position ... Support for other regions may occasionally be required. The UM Medical Director will ensure...and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent… more
- Houston Methodist (Katy, TX)
- At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible for strategic, administrative, and operational leadership for the ... Utilization Management ( UM ) department across the Houston...Houston Methodist system. This position oversees all aspects of utilization review to ensure medical necessity, level… more
- Houston Methodist (Katy, TX)
- …overtime percentage, and other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, ... medical necessity, level of care, and payer requirements. Reporting to the Director of Centralized Utilization Review, the Centralized Manager, UR position… more
- UTMB Health (Webster, TX)
- …or hospital transfers. If unsuccessful, elevates to department leadership and Senior Medical Director . Discharge Planning + Demonstrates skill in educating ... AS 400. + Demonstrates skill in accurately entering required UM data. + Monitors and facilitates appropriate utilization...achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director .… more
- Molina Healthcare (Dallas, TX)
- …the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and ... utilization . * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Evolent (Austin, TX)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Director , Client Value** **About Evolent** Evolent Health partners with health plans and ... We are committed to transforming healthcare for the better. **Role Overview** The ** Director , Client Value** will serve as a key member of the Client Value… more
- Evolent (Austin, TX)
- …Tasks are performed within the **RN/LVN/LPN** scope of practice, under the Medical Director 's direction, using independent nursing judgement and decision-making, ... identifies and refers cases that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers quality issues to UM… more
- Evolent (Austin, TX)
- …participate in meetings as assigned with practices and/or payers. + Will work with the Director of UM to ensure client satisfaction. + Perform all peer clinical ... for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the… more