- CVS Health (Austin, TX)
- …external constituents in the coordination and administration of the utilization /benefit management function.* Meet set productivity and quality expectations ... of clinical experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience + Must have active current and unrestricted… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and retrospective ... to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Elevance Health (Houston, TX)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- CVS Health (Austin, TX)
- …Nursing Licenses as business needs require **Preferred Qualifications** + Utilization Management experience preferred **Education** Diploma RN acceptable; Associate ... clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience **Anticipated Weekly Hours** 40 **Time Type**… 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
- 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