- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... and upkeep of credentials required for privileging and re-privileging. Staff Management : Participate in the FPPE/OPPE process. Adhere to employee health… more
- Wolters Kluwer (Austin, TX)
- …including: + Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations + Overseeing contract ... + Closely managing the deal through closure and keeping management informed of any risks or delays + Retaining...level and other key decision makers + Excellent account management skills and ability to manage external and internal… more
- Ascension Health (Austin, TX)
- …stakeholder and business demands, and assesses and implements appropriate resource utilization . + Participate in labor management projects, providing support ... **Details** + **Department:** Labor Management + **Schedule:** Full-time + **Location:** Austin, TX **Benefits** Paid time off (PTO) Various health insurance options… more
- Humana (Austin, TX)
- …20% 2. Review and monitor Contract Change Orders and evaluate impact on Utilization Management processes. Organize and facilitate Change Order workgroup and ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Advise executives… more
- Elevance Health (Grand Prairie, TX)
- …**Carelon Medical Benefits Management ** **Post Acute Care Benefit Utilization Management ** **Schedule: 10:00-7:00 Central Time** **** **Virtual:** This ... Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… more
- Molina Healthcare (Dallas, TX)
- …strategy. **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and direction to Centralized Pharmacy Utilization Management team + Acts as liaison to internal ... + Develops policies and procedures as needed. + Participates in Quality Management and Health Education programs including, but not limited to, NCQA Accreditation,… more
- Actalent (Houston, TX)
- …Your main role will be utilizing your clinical skills to complete utilization management reviews (Prior authorizations, Coverage Exceptions, Quantity Limit ... also be cross-trained for other departments, such as the Medication Therapy Management (MTM) team or Call Center Counselling (CCC). + Additional training… more
- Centene Corporation (Austin, TX)
- …analysis, and/or ROI evaluation preferred. Familiarity with claims payment, utilization management , provider/vendor contracts, risk adjustment for government ... years of experience working with large databases, data verification, and data management or 2+ years of IT experience. Healthcare analytics experience preferred.… more
- UTMB Health (Galveston, TX)
- …system data entry of information such as referral requests, drug utilization management information, prepacking information, drug purchasing information, or ... medications + Participates in the operations of medication therapy management + Initiates medication reconciliation + Assists with screening, documentation,… more
- Houston Methodist (Houston, TX)
- …in a hospital setting + Two years of experience in Hospital Quality Improvement, Case Management or Utilization Management role preferred + Two years of ... leadership experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure within 60 days **OR** + RN-Temp - Registered Nurse - Temporary State Licensure within 60 days **LICENSES… more