- CommonSpirit Health (Houston, TX)
- …intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case… more
- Highmark Health (Austin, TX)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Sharecare (Austin, TX)
- …and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective ... nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Houston Methodist (Houston, TX)
- …data management support to the department staff to facilitate efficient utilization of resources including referrals management, communication and collaboration with ... Medicare, Medicaid, and managed care reimbursement methodologies** + **Ability to review clinical documentation for Medical Necessity and payer requirements** +… more
- CVS Health (Austin, TX)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- iHeartMedia (San Antonio, TX)
- …action to get account back on track, and provide account recaps + Review and maintain accurate product pricing, analyze sales proposals and orders to ensure ... inventory utilization is optimized accurately + Generate reporting on sales...Assistance Program (EAP) at no cost - services include telephonic counseling sessions, consultation on legal and financial matters,… more
- CVS Health (Lumberton, TX)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... appropriate under the direct supervision of a licensed pharmacist + Taking telephonic prescriptions from the prescriber, and calling the prescriber to clarify… more
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