- 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
- 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
- Prime Healthcare (Weslaco, TX)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/219738/manager-of-health-information- management medical ... Overview Knapp Medical Centeris a 227-bed not-for-profit, acute care hospital,...Foundation. Located in Weslaco, TX, we provide exceptional healthcare services to residents of the Mid- Valley. Knapp works… more
- Travelers Insurance Company (Austin, TX)
- … capabilities to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon ... **What Is the Opportunity?** Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader medical … more
- Centene Corporation (Austin, TX)
- … to health plan members. + Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all ... medical management determinations. + Provide leadership and expertise in the development, implementation and interpretation of medical review and quality… more
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