- Evolent (Austin, TX)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... and write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet all accreditation,… more
- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process improvement and enhancement of… more
- CVS Health (Austin, TX)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...UM (Utilization Management) experience *Active and current state medical license without encumbrances *M.D. or DO, Board Certification… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Austin, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (San Antonio, TX)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... * Provide regional medical necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to… more
- Molina Healthcare (Houston, TX)
- …Services. * Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina Medicare and Medicaid on early ... 2 years in a manager role. * Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery,… more
- Catholic Health Initiatives (Houston, TX)
- …to maintain effective team leadership and oversight. This role supports the UM Director in ensuring efficient operations with all processes, policies, ... **Responsibilities** The Utilization Management ( UM ) Manager is responsible for managing day-to-day UM operations within the markets, focusing on effective team… more
- Houston Methodist (Sugar Land, TX)
- …assurance and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with medical ... other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, Precertification and… more
- MTC (Anson, TX)
- …to the health services administrator, and clinically to the MTC Corporate Medical Director . Responsible for providing medical services related ... Full time, Monday - Friday, day schedule** **Benefit package includes:** + ** Medical , Vision, Dental, and Prescription Drug Benefits** + **Life, Accidental Death and… more