- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Houston Methodist (Houston, TX)
- …strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible ... enterprise-wide initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes, and… more
- Molina Healthcare (San Antonio, TX)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... for serving as the primary liaison between administration and medical staff . Assures the ongoing development and implementation of policies and procedures… more
- Molina Healthcare (Fort Worth, TX)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- AdventHealth (Mansfield, TX)
- …performance with oversight to assure capital and fiscal accountability. + Partners with Utilization Management for the Utilization Review Committee as well ... career with AdventHealth, named in 2018 by Beckers Hospital Review as one of the 150 Top Places to...involving physicians and multiple hospital departments, to assure appropriate utilization of hospital resources, appropriate level of care for… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs… more
- Molina Healthcare (Fort Worth, TX)
- …teams including care management, care coordination, transitions of care, utilization management (prior-authorization, inpatient review ), behavioral health, ... services professionals, in some or all of the following functions: utilization management, care management, care transitions, behavioral health, long-term services… more
- Elevance Health (Houston, TX)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...regimens. + As necessary, assist pre-certification nurses and other staff in understanding the principles behind appropriate utilization… more
- HCA Healthcare (Dallas, TX)
- …related to the electronic health record (EHR) including: + standardization + utilization + integration + optimization The DCI is responsible for development, ... AND DUTIES:** + Implementation and support of facility-wide standardization, utilization , integration, and optimization activities related to the EHR and… more
- Houston Methodist (The Woodlands, TX)
- …Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient ... EPIC and MIDAS + Serves as a preceptor, as appropriate, and implements staff education specific to patient populations and unit processes; coaches and mentors other… more