- CenterWell (Eastland, TX)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Sedgwick (Austin, TX)
- …use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, trends, and ... data collection. + Interacts and coordinates work of physician advisors as needed; performs complex review of cases to identify referral for case management as… more
- HCA Healthcare (Dallas, TX)
- …and patient throughput while supporting a balance of optimal care and appropriate resource utilization . What You Will Do In This Role: + The Case Manager will assist ... regulation pertaining to federally funded programs as they relate to utilization review, discharge planning and financial reimbursement. + Conducts initial… more
- Humana (Austin, TX)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post… more
- Houston Methodist (The Woodlands, TX)
- …benefits for patients and reimbursement for the hospital. + Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource ... utilization , and continued stay. + Participates in denial mitigation...wellness services; an outpatient laboratory; and several other multispecialty physician practices. In January 2022, Houston Methodist The Woodlands… more
- Humana (Austin, TX)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or… more
- Molina Healthcare (Fort Worth, TX)
- …and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports ... medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft… more
- Grifols Shared Services North America, Inc (Dallas, TX)
- …"Account List" of Health Systems designed to increase the adoption and utilization of the Grifols Bleeding Management product portfolio. The KAM's primary ... and their team of Specialty Sales Representatives to develop physician influencer champions to submit and approve P&T requests...the MSL Team should a need arise **KAM Resources Utilization ** + Maintain updated and accurate CRM Data +… more
- HCA Healthcare (Austin, TX)
- …may include: payor mix, historical volume data (prior payment history, volumes, utilization ), coverage and scope of services. The Contract Manager will also ... to set up new contractors in company systems. + You will record Physician -Related Reportable Incidents + You will submit and research contracted physician… more
- HCA Healthcare (Dallas, TX)
- …and receive healthcare, attracting physicians, caregivers, and patients. Ensures physician alignment, engagement, and ease of access/practice. + Leverages various ... to enhance existing services or develop new service offerings, and participates in physician recruitment as needed by division and facility + Stays abreast of… more