- Texas Health Resources (Plano, TX)
- …Credentials Committee to coordinate medical staff credentialing including the review of credentials, delineation of clinical privileges, development of privileges, ... Work with the quality department and medical staff leadership to conduct robust peer review . b. Support the Quality Department and Medical Staff Leadership in Peer … more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient ... approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital… more
- Fresenius Medical Center (Uvalde, TX)
- …the designated clinical application accurately and in a timely manner. + Review treatment sheets for completeness ensure nursing signatures are documented and ensure ... appointments + Weigh patient and obtain vital signs + Collect treatment records and review for completion. Notify RN of incomplete / missing records. + Cleaning and… more
- Molina Healthcare (Dallas, TX)
- …reports and automated configuration processes/solutions + Assist manager in establishing peer review standards and methodology + Leads peer reviews + Leads the ... of large, complex, critical configuration maintenance processes/solutions + Research and review new tools and techniques and provide recommendations to management +… more
- Prime Therapeutics (Austin, TX)
- …signoff of deliverables by all impacted parties + Lead solution design review discussions between IT resources and business requestors to resolve questions regarding ... software changes, and participate with Quality Assurance and UAT resources to review related test cases and/or scenarios + Lead highly complex projects where… more
- Humana (Austin, TX)
- …They will develop and maintain team best practices such as peer review and documentation. The Lead Actuary will be responsible for Medicaid-specific functions ... such as capitation rate review , drafting rate advocacy communications, actual-to-expected business analytics, forecasting market-specific financial results, and many… more
- Fresenius Medical Center (Fort Worth, TX)
- …the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... **LICENSES:** + HighSchooldiplomaorG.E.D. required. + Must meet Center for Medicaid/ Medicare Services (CMS)-approved state and/or national certification requirements within… more
- Houston Methodist (Houston, TX)
- …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... discharge planning, progression of care, documentation of improvement, and Medicare Conditions of Participation. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Ensures a… more
- CVS Health (Austin, TX)
- …Senior Manager, Network Management:** * Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of ... and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna's established policies.… more
- Community Hospital Corporation (Plano, TX)
- …month end reporting to CHC has been loaded. Analyze contractuals monthly and review trends, identify issues causing changes and or discrepancies, etc. + Oversee / ... daily cash receipts analyzing discrepancies. Reviews all balance sheet reconciliations and completes the review of the Post Closing Review Guide by the 25th of… more