- Insight Global (Houston, TX)
- …the CMOs. Lead Epic build efforts related to case management and utilization review , including updates driven by Medicare guidelines. Support the upcoming ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- CVS Health (Austin, TX)
- …Aetna's Law Document Center regarding litigation; lawsuits. Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in ... for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums… more
- Genesis Healthcare (Dallas, TX)
- …Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area Director in the hiring ... and coordinates the timely completion of the annual merit review for therapy staff. 8. Assumes responsibility for hiring...period of one year. 5. A thorough knowledge of Medicare and third party billing is also required. Posted… more
- UTMB Health (Galveston, TX)
- …+ Completion of a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) + No experience ... plan of care that encompasses evidence-based practice guidelines, practice protocols, Medicare , Medicaid, and other state and federal regulations. + Prescribes… more
- HCA Healthcare (Pasadena, TX)
- …are high. **What you will do in this role:** + Coordinate NCD/LCD/LCA review process at the Division level + Determine whether new/revised NCDs/LCDs/LCAs apply to ... resolution + Monitor compliance with HCA Healthcare Policy REGS.GEN.011, Medicare - National and Local Coverage Determinations + Government/Non-government medical… more
- CenterWell (Arlington, TX)
- …quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally… more
- Gentiva (Amarillo, TX)
- …Group (IDG), as assigned, including presiding over IDG, presentation of patients for review , coordination of minutes, review of patient charts to note and ... practice, including industry standards, regulations, and best practices (ie, Medicare , Medicaid, JCAHO, ACHC), company policies/procedures, and understanding ofterminally… more
- HCA Healthcare (Jourdanton, TX)
- …appropriate prescribing, route, method of administration, and length of therapy; includes review of allergy history on all patients and weight for weight-based ... requirements or regulation to include the following: The Joint Commission, Medicare , Medicaid, Texas State Board of Pharmacy, Drug Enforcement Agency, Federal… more
- Fresenius Medical Center (Olmito, TX)
- …state regulations, and accrediting agency standards where applicable. + Participate in review business and finances of the site, including financial reports, market ... as appropriate in accordance with company policy + Drive employee performance review and employee engagement/recognition activities for center + Participate in the… more
- Prime Therapeutics (Austin, TX)
- …monitor aspects of compliance and validate policies, procedures, support and review of member/provider communications, manuals and materials. This role supports the ... or PBM organization, or other highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more