- CenterWell (Austin, TX)
- …of our caring community and help us put health first** The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support ... service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- 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
- Medical Center Hospital (Odessa, TX)
- + Position Summary: Assists UM Department with utilization reviews processes, including the collection and analysis of various computer-based data related to ... Utilization Review, Care Coordination, and Commercial Insurance. 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
- Ascension Health (Georgetown, TX)
- …1-2 years of Health Plan experience, preferred. + 1-2 years of Utilization Management experience, preferred. + High call phone volume experience, preferred. ... \#LI-Remote **Why Join Our Team** Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered… more
- CVS Health (Austin, TX)
- …Schedule for this position is 8:00 - 5:00 PM CST with Weekends. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for ser‐ ... vices requiring precertification. The majority of the time is spent at a desk and on the phone col‐ lecting and reviewing clinical information from providers. Precertification nurses use specific crite‐ ria to authorize procedures/services or initiate a… more
- CenterWell (Austin, TX)
- …care continuum. The incumbent will play a pivotal role in reducing acute care utilization for top 5% of complex patients and ensuring seamless transitions of care ... care facilities that ultimately improve care standardization and resource utilization , reduce readmissions and enhance/optimize patient outcomes, satisfaction, and… more
- UTMB Health (Friendswood, TX)
- …quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/Case Management program by utilizing clinical knowledge, expertise, approved ... JOB FUNCTIONS_** **:** + Supervises the operational management of the Utilization Review/Case Management program to ensure high quality, cost effective… 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 (The Woodlands, 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