- Houston Methodist (Houston, TX)
- …and relationships with payers; physician practice patterns; documentation and over- and under- utilization of resources. This position is a key member and leader of ... the hospital's utilization review/management committee, which is charged with regulatory goals...length of stay, and quality issues. + Chair the utilization review/management committee, actively participates in defining operational strategic… more
- Wolters Kluwer (Dallas, TX)
- …Engagement Manager plays a high-impact role in managing strategy and product utilization across the Wolters Kluwer Health's Clinical Decision Support & Provider ... are established and strengthened, drive product adoption and ensure utilization goals are achieved to maximize value realization, implementation projects… more
- Highmark Health (Austin, TX)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving key technical ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements for… more
- Molina Healthcare (Fort Worth, TX)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure ... most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient ... from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient...to obtain authorization for services as needed. * Conduct utilization reviews to monitor and optimize the use of… more
- Evolent (Austin, TX)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… 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 for ... initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes, and strengthening… more
- ChenMed (Houston, TX)
- …patient/family conferences to review treatment goals and optimize resource utilization ; provides family education and identifies post-hospital needs. + Serves ... reports adverse occurrences, and performs staff education related to resource utilization , discharge planning and psychosocial aspects of healthcare delivery. +… more
- RxBenefits (Houston, TX)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
- Evolent (Austin, TX)
- …As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more