- Evolent (Austin, TX)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...MD review process to reflect appropriate utilization and compliance with… more
- Molina Healthcare (Fort Worth, TX)
- …Supports BH committees for quality compliance. * Implements clinical practice guidelines and medical necessity review criteria * Tracks all clinical programs for ... of sanctions from Medicaid or Medicare. **Preferred Experience** * Peer Review , medical policy/procedure development, provider contracting experience. *… more
- Evolent (Austin, TX)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...MD review process to reflect appropriate utilization and compliance with… more
- Elevance Health (Houston, TX)
- … medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy ... **Clinical Operations Medical Director** **Carelon Medical Benefit Management** **Radiation Oncology** **Virtual:** This role enables associates to work… more
- Molina Healthcare (Austin, TX)
- …quality compliance. * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all clinical programs ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of… more
- Humana (Austin, TX)
- …insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed ... caring community and help us put health first The Medical Director actively uses their medical background,...first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether… more
- Molina Healthcare (San Antonio, TX)
- …Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- ProSphere Tek (Los Fresnos, TX)
- …documentation requirements, time requirements, functions, and workflow to process electronic medical records, to review records for accuracy and completeness, ... Planned Systems International (PSI) joint venture, is seeking a Medical Records Technician to support the ICE Health Services...for Cognito, you will utilize your abilities as a Medical Records Technician to provide the safe delivery of… more
- Gentiva (Bellaire, TX)
- …Maintain and close medical records in accordance with company policy. + Review medical records to ensure completeness and compliance with written criteria. + ... Ensure Compliance. Support Compassionate Care.** We are seeking a dependable and detail-oriented Medical Records Clerk to join our hospice care team. In this vital… more
- HCA Healthcare (Houston, TX)
- …we encourage you to apply for our Clinical Nurse Coordinator Acute Inpatient Medical opening. We review all applications. Qualified candidates will be contacted ... the career opportunities as a Registered Nurse Acute Inpatient Medical you want in your current role? We invest...exciting opportunity for you to join HCA Houston Healthcare Medical Center which is a part of the nation's… more