- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- Immigration and Customs Enforcement (Los Fresnos, TX)
- …health assessment, evaluation, and diagnosis of detained non-citizens (including the utilization of the DSM-V to formulate findings). Provides supportive counseling, ... as appropriate (may be delivered in-person or virtually). Utilizes the electronic medical record (EMR) to complete clinical documentation, and to review … more
- Houston Methodist (Houston, TX)
- …measures. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Communicates effectively to ensure proper review of donor medical history and diagnostic data; allocation ... and labeling of organs for transplantation; facilitating organ offer review and acceptance processes, recipient admission and pre-operative preparation...sequencing; and recipient medical information, current medical status, and crossmatch… more
- Houston Methodist (Houston, TX)
- …of Medicare, Medicaid, and managed care reimbursement methodologies** + **Ability to review clinical documentation for Medical Necessity and payer requirements** ... serving as an initial point of contact for patients, employees, vendors, clients, medical staff and other callers seeking help from the department. This position… more
- Axiom Medical (TX)
- …for quarterly business reviews for all key clients in book of business including utilization review + Forecast and track key account metrics (eg program KPI's, ... quarterly sales results and annual forecasts) Qualifications: The successful candidate should have a combination of demonstrated experience and education that is equivalent to 5 years with a focus on account management or related fields. Physical Requirements:… more
- Medical Center Hospital (Odessa, TX)
- …of the Trauma patient is required. One year experience in performance improvement, utilization review and teaching is preferred. C. Job Knowledge Comprehensive ... knowledge of professional standards of nursing; Knowledge of accreditation and regulatory agencies' standards and guidelines. Demonstrate by previous experience and accomplishment an ability to apply a broad knowledge base to complex clinical problem solving… more
- HCA Healthcare (Dallas, TX)
- …is recognized. Submit your application for our Clinical Pharmacist Specialist BMT opening with Medical City Dallas today and find out what it truly means to be a ... part of the HCA Healthcare team. **Benefits** Medical City Dallas, offers a total rewards package that...in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement… more
- Houston Methodist (The Woodlands, TX)
- …quality, patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and ... Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker Case Manager to assess psychosocial… more
- Evolent (Austin, TX)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Genesis Healthcare (Dallas, TX)
- …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time team members. + **Support ... Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area Director in the hiring… more