- HCA Healthcare (Houston, TX)
- …admissions and assigning extended stays in accordance with criteria approved by the Utilization Management Committee and Medical Staff with referral of all cases ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...in question to the Utilization Management Physician Advisor. + Communicates with… more
- Houston Methodist (Houston, TX)
- …of Medicare, Medicaid, and managed care reimbursement methodologies** + **Ability to review clinical documentation for Medical Necessity and payer requirements** ... serving as an initial point of contact for patients, employees, vendors, clients, medical staff and other callers seeking help from the department. This position… more
- Veterans Affairs, Veterans Health Administration (Abilene, TX)
- …coordinated care delivery model. Coordinates] with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Cognizant (Austin, TX)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or...years' claims processing experience is required. + Knowledge of physician practice and hospital coding, and medical … 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
- Fresenius Medical Center (Plano, TX)
- …coding. + Chart Analysis, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses ... and procedures. Adheres to Standards of Ethical Coding (AHIMA/AAPC). Reviews medical records for the determination of accurate assignment of all documented diagnoses… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- CenterWell (Eastland, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- HCA Healthcare (Dallas, TX)
- …staff performance evaluations. + Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other evidenced based ... and from other countries. We offer sophisticated treatment by our 400+ in-house physician specialists. Medical City Dallas has a full-service adult hospital and… more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay...countries. We offer sophisticated treatment by our 400+ in-house physician specialists. Medical City Dallas has a… more