- Healthfirst (TX)
- …+ Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of Centers for Medicare & Medicaid Services ( CMS ) or New York State + Department of ... The Case Manager, Utilization Management coordinates the care plan for assigned members...and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager, Utilization Management… more
- Molina Healthcare (TX)
- …contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability ... staff to determine; for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer… more
- Prime Therapeutics (Austin, TX)
- …benefits consultants, key state leaders, industry trade associations, and Centers for Medicare and Medicaid Services ( CMS ); establish an effective communication ... teams, ensuring adequate representation for market-specific client needs; align account management activities across all lines of business and develop methodologies,… more
- Fresenius Medical Center (Olmito, TX)
- …Preparedness Plan; ensure maintenance of equipment + Ensure proper medical records management and HIPAA compliance + Oversees the continuous and data driven Quality ... and policies, and then developing and implementing an associated center specific management plan. + Ensure adverse events are reported, documented and necessary… more
- UTMB Health (Friendswood, TX)
- …experience in the management of population health-related programs such as health system management , health plans, or public health or Project or program ... quality metrics as identified. + Organize Quality and Risk Management meetings. + Make recommendations to the CBC administrative...academic health system or integrated healthcare delivery system + Experience with Medicare , Medicaid, or… more
- Prime Healthcare (Weslaco, TX)
- …in the United States in the various areas we serve: + Centers For Medicare & Medicaid Services ( CMS ) Five-Star Quality Rated + LeapFrog Hospital Safety ... (PALS). Responsibilities + The Director is responsible for implementation, ongoing management and strategic growth of the program: outpatient Wound Care Center… more
- Molina Healthcare (San Antonio, TX)
- …Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. + Provides… more
- HCA Healthcare (Pasadena, TX)
- …updates via Regs NCD/LCD/LCA Communications, Regs Coverage Corner issues and CMS and MAC Listservs to update appropriate ancillary departments and physicians ... resolution + Monitor compliance with HCA Healthcare Policy REGS.GEN.011, Medicare - National and Local Coverage Determinations + Government/Non-government medical… more
- HCA Healthcare (Dallas, TX)
- …programs while driving growth, standardization, and innovation across the system in collaboration with the current facility-based transplant administrators. The ... a financial infrastructure that ensures efficiency, optimizes cost capture for Medicare Cost Reports, and improves reimbursement strategies. + Work with Corporate… more
- HCA Healthcare (Houston, TX)
- …daily ancillary charge report to identify any potential charging issue related to system failures, system updates or other. Reviews denial trends for ... deactivation, or modification). + Review HCA regulatory communications, applicable CMS transmittals, and Local Coverage Determinations (LCDs), assess their impact… more