- Prime Therapeutics (Austin, TX)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral… more
- HCA Healthcare (Tomball, TX)
- …Tomball we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Case Manager and access programs to assist with every stage of your ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...certifications and job skills. Apply today for our Registered Nurse RN Case Manager opening and continue to learn!… more
- CVS Health (Austin, TX)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and… more
- HCA Healthcare (Austin, TX)
- …passionate about delivering patient-centered care?** Submit your application for Operating Room Nurse position and spend more time at the bedside with the patient. ... 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
- HCA Healthcare (Houston, 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 ... and behavioral health coverage as well as telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
- Elevance Health (Houston, TX)
- **Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- CVS Health (Dallas, TX)
- …Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage, and policies.` ... be responsible for, care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. + Strong assessment,… more
- Molina Healthcare (Dallas, TX)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (Austin, 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
- 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