- CenterWell (Arlington, TX)
- …defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. + Participates in potential ... be screened for TB **Preferred Qualifications:** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of two to five… more
- Humana (Austin, TX)
- …requiring minimal instructions to achieve solutions. May provide coaching and/or review the work of lower-level associates. Makes decisions on moderately complex ... RN or a related field, or equivalent work experience + Experience with Medicare and/or managed care + Understanding of NCQA and CMS Stars Rating System… more
- Molina Healthcare (Austin, TX)
- …needed + Primary point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings ... processes and established guidelines; provides appropriate follow up on peer review findings + Identifies, defines and communicates opportunities for improvement to… more
- CenterWell (El Paso, TX)
- …defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. + Participates in potential ... role, you will be required to be screened for TB **Preferred Qualifications:** + Medicare Provider Number + Medicaid Provider Number + Minimum of two to five years… more
- Robert Half Legal (Frisco, TX)
- …involves ensuring adherence to healthcare regulations, particularly in the Medicare Advantage space, while supporting key compliance initiatives and investigations. ... organizational activities to ensure compliance with healthcare regulations and laws. * Review and update policies and procedures to align with current regulatory… more
- Prime Therapeutics (Austin, TX)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Houston Methodist (Sugar Land, 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
- Actalent (Austin, TX)
- …Technician to join our team. In this role, you will primarily support Medicare and Medicaid patients by managing the intake and processing of prior authorizations. ... entering prior authorization requests into our system and coordinating with review technicians. Training opportunities are available for those interested in… more
- Houston Methodist (The Woodlands, 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