- Cherry Bekaert (Austin, TX)
- …Resource Coordinator will effectively fill resource engagement requests overseeing the utilization of resources, ensuring alignment of resources with the strategic ... Serve as a trusted business advisor for service leads. + Generate scheduling, utilization and forecasting reports and provide analysis of the data that assists… more
- Houston Methodist (Houston, TX)
- …measures. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Communicates effectively to ensure proper review of donor medical history and diagnostic data; allocation ... and labeling of organs for transplantation; facilitating organ offer review and acceptance processes, recipient admission and pre-operative preparation...sequencing; and recipient medical information, current medical status, and crossmatch… 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
- CenterWell (Austin, TX)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... a part of our caring community and help us put health first** Utilization Management Administration Coordinator II , non-clinical, supports the UM operations by… more
- Abbott (Plano, TX)
- …insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor ... small groups. + Attention to detail. + Ability to travel 5% of the time. + Excellent organization skills...Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . + Experience in medical… more
- Highmark Health (Austin, TX)
- …The Senior Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal ... insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes… more
- Houston Methodist (The Woodlands, TX)
- …quality, patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and ... Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker Case Manager to assess psychosocial… 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...recognized as the world's best in their specialties. Patients travel to Medical City Dallas from all… more
- Humana (Austin, TX)
- …Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + ... and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- AECOM (Houston, TX)
- …in order to be able to identify support personnel and facilitate the quality review process for any regional project. In the event quality issues are identified, ... major pursuits by actively participating in the development and review of Project Plans and incorporation of other project...set up tools. + Support operations by balancing architecture utilization and staffing across the region as well as… more