- Molina Healthcare (Houston, TX)
- …our Marketplace business. The candidate must have an RN licensure. Experience with UM medical review and prior authorization is a bonus. PEGA knowledge is highly ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Houston Methodist (Houston, TX)
- …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
- CVS Health (Austin, TX)
- …for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on ... rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to… 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 ... technical/connection issues **Essential Functions of the Role** + You will review medical services. Use guidelines to assess appropriateness. + Evaluate patient… 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 ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. **Preferred… more
- Travelers Insurance Company (Austin, TX)
- …influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State ... regulations and medical guidelines to establish medical review policies. Works in close collaboration with the Claim leaders and in partnership with other … more
- Sedgwick (Austin, TX)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...+ Member of a client Disability Pension Board + Review of identified appeal cases for quality assurance purposes… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- Sumitomo Pharma (Austin, TX)
- …including pre- and post-marketing US FDA and/or EU ICH safety requirements** + Expertise in medical review of medical review of Individual case safety ... dynamic, highly motivated, and experienced individual for the position of **Associate Medical Director.** The Associate Medical Director will provide hands-on… 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
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