- Humana (Austin, TX)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health ... part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice… more
- Baylor Scott & White Health (Dallas, TX)
- …Leads, guides and facilitates physician/APP relations, recruitment, credentialing and peer/chart review activities. 8. Evaluates new developments in medical care ... vary based on position type and/or level **Job Summary** The Urgent Care Medical Director is responsible for enhancing the planning, overseeing, and directing of … more
- Fresenius Medical Center (Humble, TX)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs… more
- CVS Health (Austin, TX)
- …Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual ... Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for ...based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols. + Serve… more
- Cognizant (Austin, TX)
- …guidelines and regulations + Experience in the analysis and processing of claims, utilization review /quality assurance procedures + Must be able to work with ... Based** Claims Processors to join our growing team. The ** Medical ** **Claims Processor** is responsible for the timely and...HCFA paper, or EDI information. + Responsible for reviewing medical records when necessary to determine if the service… more
- Fresenius Medical Center (Houston, TX)
- …communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with ... as pertinent. **STAFF:** + Responsible for implementation of FMS staffing, and medical supply models, to provide quality patient care, and makes recommendations. +… more
- Houston Methodist (Houston, TX)
- …many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, ... and prioritize daily tasks. Provides leadership to staff on efficient utilization of time according to budgetary guidelines. Reviews team member's timecards… more
- Houston Methodist (The Woodlands, TX)
- …for employee engagement, ie peer-to-peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and ... for the hospital. + Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care… more
- Houston Methodist (The Woodlands, TX)
- …needs for the department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... for the hospital. + Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care… more