- Molina Healthcare (Fort Worth, TX)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease ... productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical ...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Molina Healthcare (Houston, TX)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... School of Nursing. **Required Experience** 3+ years hospital acute care/ medical experience. **Required License, Certification, Association** Active, unrestricted State… more
- UTMB Health (Friendswood, TX)
- …liability. + Educates the Medical Staff and Nursing Staff on the Utilization Review /Case Management program and provides specific information related to case ... quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical... of quality of care issues arising during concurrent review , and identifies areas of potential medical … more
- HCA Healthcare (Live Oak, TX)
- …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more