- 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
- 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
- Highmark Health (Austin, TX)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities...care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy… more
- Humana (Austin, TX)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Houston Methodist (Sugar Land, TX)
- …The Sr. MA position participates in patient care which is under the direction of a physician and within the scope of a medical assistant. This position may also ... blood pressure, weight, and height), chief complaint(s), preforms medication(s) review , discusses/reviews medical and social history (as appropriate).… more
- Travelers Insurance Company (Austin, TX)
- …other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. + Stay apprised of ... influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State… more
- Houston Methodist (Houston, TX)
- …The MA position participates in patient care which is under the direction of a physician and within the scope of a medical assistant. This position may also ... blood pressure, weight, and height), chief complaint(s), preforms medication(s) review , discusses/reviews medical and social history (as appropriate).… more
- Humana (Austin, TX)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more