- CVS Health (Austin, TX)
- …including post-graduate direct patient care experience specifically. This role expands Aetna's medical management programs to address member needs across the ... continuum of care. In this role you'll support the Medical Management staff ensuring timely and consistent...providers and facilities to support the effective execution of medical services programs by the clinical teams… more
- Elevance Health (Grand Prairie, TX)
- …/Anesthesia Appeals** is responsible for the review of appeals for physical health medical services , to ensure the appropriate and most cost effective ... ** Medical Director-Pain Management /Anesthesia Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of required… more
- CVS Health (Arlington, TX)
- …services . Promotes communication, both internally and externally to enhance effectiveness of medical management services (eg, health care providers, and ... Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening...clinical staff Identifies triggers for referral into Aetna's Case Management , Disease Management , Mixed Services ,… more
- Highmark Health (Austin, TX)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan;...**Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral &… more
- Humana (Austin, TX)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management . + Utilization management experience in a medical management review organization,… more
- Humana (Austin, TX)
- …industry including Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization,… more
- Humana (Austin, TX)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management . + Utilization management experience in a medical management review organization,… more
- Elevance Health (Grand Prairie, TX)
- …people we serve. The medical director supports product strategy/design through medical management that impact health care quality, cost, and outcomes, and ... Director** is responsible for serving as the Operational Medical Director for our care management models...the clinical relevance to account reporting regarding use of medical services by members. Involved in identifying… more
- Centene Corporation (Austin, TX)
- …changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national ... Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions... medical review of complex, controversial, or experimental medical services , ensuring timely and quality decision… more
- CVS Health (Austin, TX)
- …Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective ... care management solutions that promote high-quality healthcare for members. We...gather necessary information. + Use established guidelines to authorize services or escalate to Medical Directors as… more