- Evolent (Austin, TX)
- …and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Houston Methodist (Houston, TX)
- …certifications + Ability to establish and maintain effective working relationships with patients, medical staff , co-workers and the public + Ability to work with ... oversight for documentation of vital signs, chief complaint(s), preforms medication(s) review , and discusses/reviews medical and social history (as appropriate).… more
- MD Anderson Cancer Center (Houston, TX)
- …Department of Melanoma Medical Oncology for all faculty, fellows, residents, students, and staff . i. Provide peer review for assessing the clinical and ... The Department of Melanoma Medical Oncology (MMO) at The University of MD...assistant, associate, or full professor. MMO includes faculty and staff involved in patient care and clinical, translational, and… more
- Fresenius Medical Center (Paris, TX)
- …+ Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + Responsible for strong Director and physician ... Quality policies and procedures are communicated to and implemented by the facility staff . + Maintains integrity of medical records and other FMS administrative… more
- YesCare Corp (Waxahachie, TX)
- …annually. + Lead quality improvement initiatives, including patient complaints, infection control, peer review , and chart audits. + Oversee referrals to external ... and Automated External Defibrillator (AED) use, maintaining required certifications. + Lead medical staff meetings and provide monthly in-service education for … more
- Molina Healthcare (San Antonio, TX)
- …Administration, Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider ... Summary** Responsible for serving as the primary liaison between administration and medical staff . Assures the ongoing development and implementation of policies… more
- CVS Health (Austin, TX)
- …medical director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers ... related to precertification, concurrent review , and appeal request. The medical director...peer coverage of denials. * Appeals - The medical director will perform appeals in their "base plan"… more
- Houston Methodist (The Woodlands, TX)
- …as well as supplies and equipment. + Serves as a liaison for the patient, medical staff , and third parties. Communicates to resolve patient access and quality ... certifications + Ability to establish and maintain effective working relationships with patients, medical staff , coworkers, and the public as well as strong… more
- Molina Healthcare (Austin, TX)
- …* Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management ... * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all...national, state, and local laws and regulatory requirements affecting medical and clinical staff . * Ability to… more
- MD Anderson Cancer Center (Houston, TX)
- …for patients by phone conversations or in writing to other physicians. * Provide peer review for assessing the clinical practice of faculty within the ... collaborative research activities, conferences, professional society activities, study sections, staff meetings, etc. * Edit and/or review presentations… more