- Evolent (Austin, TX)
- …match reviewer for Spine Surgery cases. 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
- HCA Healthcare (Live Oak, TX)
- …environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in the inpatient ... medical staff regarding clinical resource management, appropriate documents standards, utilization and quality issues, and quality improvement activities, in… more
- Evolent (Austin, TX)
- …to the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit processes ... training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts… more
- Centene Corporation (Houston, TX)
- …issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization . + Serve as primary contact for providers and act as a ... in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization , etc. + Completes special projects as assigned + Ability to travel… more
- CenterWell (Austin, TX)
- …a part of our caring community and help us put health first** Utilization Management Administration Coordinator II , non-clinical, supports the UM operations by ... duties. This role focuses on the administrative aspects of managing healthcare utilization , ensuring efficient and effective processes within the UM program. Key… more
- Actalent (Dallas, TX)
- Clinical Review Nurse ( Utilization Management)100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent reviews, ... appropriate setting of care. Essential Skills + 2+ years of utilization management and utilization review expertise. + Experience in concurrent review and prior… more
- Healthfirst (TX)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and ... case management as assigned. The Case Manager, Utilization Management is also responsible for efficient ... Utilization Management is also responsible for efficient utilization of health services and optimal health outcomes for… more
- Evolent (Austin, TX)
- …Doing:** Job Description As a FMD, Radiology 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
- Houston Methodist (Houston, TX)
- …most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs ... excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for appropriate… more
- ConvaTec (Fort Worth, TX)
- …goals. Identify, prioritize, pull-through, and close opportunities. + Ensure effective utilization of the products by all trained Health Care Professionals within ... proposition + Demonstrates clinical understanding of targeted surgical procedures + Optimize utilization of educational and KOL events (ie Examples are Trade Shows,… more