- Houston Methodist (The Woodlands, TX)
- …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
- Baylor Scott & White Health (Dallas, TX)
- …health plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify ... medical records reflect services provided, ensuring quality...issues **Essential Functions of the Role** + You will review medical services. Use guidelines to assess… more
- Molina Healthcare (San Antonio, TX)
- …Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management ... + Must have valid driver's license with good driving record and be able to drive within applicable state...Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual /… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. +...by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA… more
- Centene Corporation (Austin, TX)
- …+ Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines. + Provide ... who changes everything for our 28 million members. **Position Purpose:** Provide medical oversight, expertise and leadership to ensure the delivery of cost… more
- Prime Therapeutics (Austin, TX)
- …Expert within the organization. + Conducts Program Integrity Audits including outreach and review of medical records to audit authenticity of provider ... The Initial Review Pharmacy Technician plays a key role in medical and pharmacy management initiatives critical to the company achieving revenue goals and… more
- Sumitomo Pharma (Austin, TX)
- …Initiated Study and Collaborative Research program. + Provide detailed and compliant medical review and approval of external resources, communications, and ... as appropriate. + Capable of translating brand goals and objectives into actionable medical and scientific strategies. + Proven track record of detailed,… more
- Humana (Austin, TX)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... health topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of moderately complex… more
- Humana (Austin, TX)
- …to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director's work includes computer-based review of moderately complex to ... complex clinical scenarios, review of all submitted clinical records , prioritization of daily work, and communication of decisions to internal associates. The… more
- Humana (Austin, TX)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... complex clinical scenarios, review of all submitted clinical records , prioritization of daily work, communication of decisions to internal associates, and… more