- USAA (San Antonio, TX)
- …seeking a talented **Life Special Investigations Unit Investigator I (Mid-Level)** to review , analyze, and investigate life, health, and annuity claims to ensure ... and other agencies as appropriate. As a Mid-Level Life SIU Investigator for ** Medicare Supplement Fraud, Waste, and Abuse** you will support the Life Special… more
- Elevance Health (Grand Prairie, TX)
- **Medical Director- Medicare (Part-time)** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of physical and/or behavioral… more
- Humana (Austin, TX)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Austin, TX)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Centene Corporation (Austin, TX)
- …applicable), peers, and other employees. Work with the training team to create/ review training materials. + Prepare and deliver documents for Program Steering ... required. Healthcare experience and/or managed care experience preferred. Experience with Medicare or CMS bid filing strongly preferred. Pay Range: $86,000.00 -… more
- Molina Healthcare (Fort Worth, TX)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** + Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
- Houston Methodist (Houston, TX)
- …+ Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care ... At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered...Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),… more
- Molina Healthcare (San Antonio, TX)
- …unrestricted State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review , medical policy/procedure development, ... quality and financial goals across all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the BH MD lead trainers in the… more
- Houston Methodist (Houston, TX)
- …study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review . - Reviews Medicare Coverage Analysis to ensure completion prior to ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Humana (Austin, TX)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more