- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Humana (Austin, TX)
- …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… more
- Humana (Austin, TX)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Humana (Austin, TX)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. o Review dental ... claims consistent with current ADA CDT terminology and current professional standards o Review and resolve provider and member grievances and appeals o Provide and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the achievement of ... an expert level at all objectives delineated in the Utilization Review Nurse and Utilization ...Functions as a resource to department staff in communicating medical information required by external review entities,… more
- Molina Healthcare (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 (Houston, TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… 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 (Fort Worth, TX)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... - Friday 8:00 AM to 5:00 PM EST Remote position with 25% field travel MA RN license **KNOWLEDGE/SKILLS/ABILITIES** + Assists in training of all staff according to… more
- Houston Methodist (Houston, TX)
- …dashboards, workforce planning and analysis, capacity and resource utilization analytics, operational workflows, provider template management, time study ... operational performance metrics and initiatives by developing tools to assess utilization of organizational resources. In addition, this position is responsible for… more