- Molina Healthcare (San Antonio, TX)
- …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines.… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC...measures to achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director. ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- Medical Center Hospital (Odessa, TX)
- …processes, including the collection and analysis of various computer-based data related to Utilization Review , Care Coordination, and Commercial Insurance. ... + Position Summary: Assists UM Department with utilization reviews… more
- Centene Corporation (Austin, TX)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Humana (Austin, TX)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... our most vulnerable members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations… more
- Molina Healthcare (San Antonio, TX)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Humana (Austin, TX)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- CenterWell (Austin, TX)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Humana (Austin, TX)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. o Review dental ... claims consistent with current ADA CDT terminology and current professional standards o Review and resolve provider and member grievances and appeals o Provide and… more