- CenterWell (Dallas, TX)
- …guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and cost expectation ... consumer experiences . **Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of three to… more
- Texas Health Resources (Dallas, TX)
- …AUDITS AND MONITORING: Develop, coordinate and oversee annual internal compliance review and monitoring work plan including processes and controls to provide ... of and comply with federal and state laws and regulations including Medicare /Medicaid program requirements. Lead and/or work with appropriate resources to ensure… more
- Houston Methodist (Nassau Bay, TX)
- …for the department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to… more
- Evolent (Austin, TX)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Austin, TX)
- …an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for… more
- Houston Methodist (Houston, TX)
- …engagement, ie peer-to-peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource ... if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to… more
- Datavant (Austin, TX)
- …the application of learning to the work environment through various methods + Review client level audits and advise training content to re-educate team on coding ... and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of Medicare… more
- Houston Methodist (Katy, TX)
- …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... Practice and performs associated actions upon non-compliance (ie, focal point review requirements, disaster plan, in services, influenza immunization, wage and hour,… more
- Houston Methodist (Cypress, TX)
- …engagement, ie peer-to-peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource ... if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to… more
- Walgreens (Dallas, TX)
- …are correctly authorized and required documentation is on file. + Ensure all Medicare documentation is received from the medical provider and submitted to Danville. ... + Review reports to maximize generic substitution opportunities. + Manage...to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance… more