- Sedgwick (Dallas, TX)
- …and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as ... and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents company in… more
- CVS Health (Austin, TX)
- …for medical necessity review of ABA. + Provide input into medical management programs/policies that pertain to neurodevelopmental disorders. + Make ... ABA prior authorization clinical team and the health plan medical directors. + Attend and participate in clinical meetings...+ Attend and participate in clinical meetings with care management and utilization management . Provide subject matter… more
- Immigration and Customs Enforcement (Houston, TX)
- …services, laboratory services, biological and hazardous waste disposal services, air management services, medical and dental equipment inspection and ... and mental health care, and public health services. IHSC provides medical case management and oversight for an additional 22,600 detainees housed at… more
- Elevance Health (Grand Prairie, TX)
- …skills, problem-solving skills, facilitation skills, and analytical skills. + Knowledge of the medical management process and the ability to interpret and apply ... **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with... plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Baylor Scott & White Health (Temple, TX)
- …of a strategic plan for pharmacy operations. This includes an integrated pharmacy and medical management model. It will reshape the care delivery system and ... evaluating the BSWH pharmacy function and services. Advises BSWH leadership, medical staff, departments, and operations on BSWH pharmacy operations. Ensures… more
- Molina Healthcare (Fort Worth, TX)
- …**Required Experience** 3 or more years in case management , disease management , managed care or medical or behavioral health settings. **Required License, ... and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** Oversees an integrated Care Management team responsible for case management , community connectors, health… more
- The Cigna Group (Austin, TX)
- …terms on profitability, trend and other metrics. You will also partner with network management , medical management , and sales units to understand resulting ... to build these into plan where appropriate + Keep management informed as to the progress of Plan and...Experience working with claim data and familiarity with standard medical coding: CPT, ICD9, HCPC preferred + Understanding of… more
- The Cigna Group (Houston, TX)
- …communication with matrix partners including but not limited to, Claims Operations, Medical Management . Credentialing, Legal, Medical Economics, Compliance, ... the Houston, TX area** The **Manager, Provider Contracting Network Management ** serves as an integral member of the Provider...position. + Creates and manages initiatives that improve total medical cost and quality. + Drives change with external… more
- ThermoFisher Scientific (Austin, TX)
- …manage multiple complex tasks . Ability to effectively manage potential emergency medical situations ** Management Role:** No management responsibility ... that people and communities depend on - now and in the future. Within Medical Communications, we improve patient health by supplying medical information services… more
- Valor Health (San Antonio, TX)
- …of the medical record within 24 hours of a patient encounter. + Solicits medical management consult or input when appropriate. + Will comply with all VA ... for the US Department of Veterans Affairs. We provide a full range of medical services to veterans through the operations of CBOCs, tailored to meet the specific… more