- 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 ... Conducts record review for performance improvement, peer review, patient safety, risk management and other projects. + Facilitates and leads process and performance… more
- NTT DATA North America (Plano, TX)
- …and implement corrective actions + Collaborate with health plans, clinical teams, utilization management , and other departments to address complex cases and ... recommendations and interpretations of records. + Prepare reports for senior management on appeal trends and compliance status. **Requirements:** + Requires… more
- 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
- UTMB Health (Galveston, TX)
- …Develops and implements quality assurance/improvement programs at the facilities. + Implements utilization management programs at the facilities. + Assumes 24 ... Galveston County Jail **Galveston, Texas, United States** **New** Nursing & Care Management UTMB Health Requisition # 2505552 The mission of Correctional Managed… more
- Molina Healthcare (TX)
- …MI_** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... substance use services and assists with implementing integrated Behavioral Health care management programs. **Job Duties** * Serves as liaison between plan and… more
- Amgen (San Antonio, TX)
- …+ Offer office education during the access process, including formulary coverage/ utilization management criteria, insurance forms & procedures, benefits ... Strong written and oral communication skills + Organizational skills and project management experience, including the ability to manage multiple projects + Strong… more
- CVS Health (TX)
- …Lead the day-to-day operations of key business projects and programs around utilization management (UM), clinical programs, and pharmacy operations. + ... user of Excel, PowerPoint, Word **Preferred Qualifications:** + Project management certification. **Education:** + Bachelor's degree preferred or a combination… more
- The Cigna Group (Houston, TX)
- …data, systems, and applications for claims payment, enrollment, benefit design, and utilization management + Knowledge of standard medical coding including ... medical expense and product pricing trends. Partners with network management and pricing units to deliver medical expense results...with a proven track record of success + Prior Management experience is preferred as there is an expectation… more
- Molina Healthcare (Houston, TX)
- …use of information from multiple sources, including claims/encounters, pharmacy, utilization management , clinical indicators, industry benchmark, and/or ... & ABILITIES:** * 7+ years experience in managed healthcare Quality/HEDIS project management and HEDIS Audit * Demonstrated knowledge of and experience with HEDIS… more
- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... and internal requirements for letter generation. * Strong organizational and time- management skills, and ability to manage multiple letter queues and deadlines.… more