- HCA Healthcare (Houston, TX)
- …integrates national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- Molina Healthcare (Fort Worth, TX)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- SHI (Austin, TX)
- …and supporting major initiative campaigns to enhance technology deployment and utilization . Role Description * Drive retention and growth by identifying customers' ... to align forecasts with sales and supply chain management. * Host Quarterly Business Review and status meetings on a regular cadence. * Engage Account Executives and… more
- HCA Healthcare (Kingwood, TX)
- …in this role: + Actively participates in the collaborative program which requires review of patient activities related to medical necessity of hospitalization, ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- CVS Health (Austin, TX)
- …day. **Position Summary:** This Case Manager RN position is with Aetna's National Medical Excellence (NME) team and is a fully remote position. Candidates from any ... is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- HCA Healthcare (San Antonio, TX)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
- KBR (Houston, TX)
- …the development and utilization of required databases. + Conduct peer (record) review s for the HP Staff as directed by governing credentialing body and local ... medical oversight process. + Assists the HP program Manager...HP program manager and/or coordinator. + Document work performed, utilization , encounters, referrals, and all other information in… more
- Ross Stores, Inc. (Dallas, TX)
- …Operations, MPT, etc\.\) and analytics\. + Identify shortage risks through regular review of indicator reports; partner with stores to develop action plans to ... the company and address new types of theft and fraud\. + Maximize utilization of all available merchandise protection tools and resources \(including EAS, domes,… more
- System One (Houston, TX)
- …Build out effective Category Strategies by performing analysis on internal utilization , external benchmarking, identify optimized cost models, and develop an ... out and leverage data sources and reports to conduct utilization analysis to monitor and manage spend data within...forecasts to manage ongoing category activities + Conduct ongoing review of market and industry trends to inform category… more
- Baylor Scott & White Health (Temple, TX)
- …and pharmacy benefit management. This includes prescription drugs, benefits design, utilization review , formulary management, and cost containment strategies. + ... include service efficiencies, process standardization, drug formulary, and drug utilization . It also involves vendor selection, productivity, performance standards,… more