- Texas A&M University System (College Station, TX)
- …as a Registered Nurse, including experience in at least one of the following areas: Prior authorizations or utilization management , c are coordination or ... Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas...experience in at least one of the following areas: prior authorizations or utilization management ,… more
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... unless an accommodation is granted as required by law._ " The ** Utilization Management Representative II** is responsible for managing incoming calls,… more
- Elevance Health (San Antonio, TX)
- ** Utilization Management Representative III** **Location:** This role requires associates to be in-office 5 days per week, at our San Antonio, TX location. The ... ** Utilization Management Representative III** is responsible for...III** is responsible for coordinating cases for precertification and prior authorization review. **How you will make… more
- Molina Healthcare (TX)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- Methodist Health System (Richardson, TX)
- …physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre- authorization and resolve ... professional responsible for verification of medical coverage, along with notification, prior authorization , and/or pre-determination of healthcare benefits for… more
- Molina Healthcare (Houston, TX)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management / prior authorization services as needed. * Supervises the… more
- Molina Healthcare (Houston, TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- CVS Health (Austin, TX)
- …and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and precertification as well as ... Independent Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience -Electronic medical… more
- Evolent (Austin, TX)
- …Analyst, Scope Management plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent ... and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work...impactful manner. + Perform other duties related to the management of prior authorization and… more
- Molina Healthcare (Fort Worth, TX)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... through Friday from 1230pm to 9pm MST. Molina Pharmacy Services/ Management staff work to ensure that Molina members have...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more