- CenterWell (Austin, TX)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- CenterWell (Austin, TX)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician Advisors. + Qualifications: A. Education: Holds a current Texas license as a… more
- Health Care Service Corporation (Richardson, TX)
- …making skills.** **PC and database experience.** **PREFERRED JOB REQUIREMENTS:** ** Utilization review experience.** **3 years clinical experience in psychiatric ... setting or behavioral health practice providing** **as a BCBA providing and/or supervising ABA treatment.** **_Experience in a school setting or working with individuals with ASD (Autism Spectrum Diagnoses)_** **_Relocation assistance will not be provided for… more
- Veterans Affairs, Veterans Health Administration (Arlington, TX)
- …THIS IS A DETAIL OPPORTUNITY - NOT TO EXCEED 120 DAYS You will render expert contract pre-award and post award expertise to all administrative and clinical services ... within the medical center and supported catchment area. Duties include, but may not be limited to the following: Develops procedures, policies, and supporting artifacts to ensure procurement activities are consistent with Federal Acquisition Regulations (FAR),… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... team partners. This position uses sound clinical judgement in the Utilization Management process and knowledge of regulatory requirements to make appropriate… more
- 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