- 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, ... and improving the department workflow and enhancing operations, using peer -to- peer accountability and identifying solutions via collaboration. Implements… 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, ... focus given to discharge plan and elimination of barriers. + Performs post-discharge review by analyzing the inpatient record to ensure that compliance with quality… more
- Houston Methodist (Houston, TX)
- …guidance, policy and procedure developed by Houston Methodist Research Institute Institutional Review Board (IRB), Food and Drug Administration (FDA) Code of Federal ... with key study personnel. + Acts as a liaison between the institutional review committees, regulatory agencies, and the investigators to ensure that protocols are… more
- Houston Methodist (Baytown, TX)
- …evidence-based practice using data and performance improvement methodologies and oversees the review , analysis, and integration of data in workflow design to support ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Highmark Health (Austin, TX)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of medical… more
- Oracle (Austin, TX)
- …problems of varying complexity where analysis of situation or data requires a review of various factors. Evaluate conditions using multiple sources of information. + ... and provide technical expertise to Product Managers. + Perform peer and code reviews for other members of the...bugs. Build and execute unit tests and unit plans. Review integration and regression test plans created by QA.… more
- Evolent (Austin, TX)
- …reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review… 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, ... of safe outcomes by monitoring and improving the department workflow, using peer -to- peer accountability, reporting near misses and/or adverse events immediately… more
- Evolent (Austin, TX)
- …reviews to be completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD … more
- Evolent (Austin, TX)
- …+ Provides clinical rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering ... available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review… more