- UTMB Health (Waco, TX)
- …information and records at all times. + Practices basic cost containment and utilization management for patient care and facility operations. + Prioritizes and ... organizes work so that required assignments are completed within specified timeframe. + Promotes positive interpersonal relationships among co-workers and Security. + Participates in in-service orientation and continuing education classes. Obtains 40 hours of… more
- Norstella (Austin, TX)
- …or Specialty pharmacy. + Comprehensive knowledge of both pharmacy and medical benefit utilization management policies + Proven ability to exceed expectations and ... achieve goals + Excellent presentation and communication skills + Strong analytical and critical thinking skills + Strong organization skills with the ability to prioritize in a dynamic environment + Self-motivated with a strong "can do" attitude **Additional… more
- Methodist Health System (Richardson, TX)
- …works with physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre-authorization and ... resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission, and strategic plans of Methodist Health System Your Job Requirements: * High School Graduate or equivalent. Some college preferred * 1 year of prior… more
- Evolent (Austin, TX)
- …care, HIPAA, provider and vendor contracting, compliance, population health (including utilization management ), Medicare, and Medicaid. + Draft, review and ... negotiate contracts with providers, vendors, managed care customers, and other third parties to ensure compliance with applicable statutes, case law, governmental regulations and Evolent policy guidelines. Analyze and advise business owners of contractual… more
- Humana (Austin, TX)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... organizations, hospitals and other healthcare providers, patient interaction, etc. + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, PM&R, Anesthesiology and General Surgery clinical specialists **Work at Home Guidance** To… more
- Baylor Scott & White Health (Temple, TX)
- …pharmacist preferred. + Proven knowledge of managed care and pharmacy benefit management . This includes prescription drugs, benefits design, utilization review, ... include service efficiencies, process standardization, drug formulary, and drug utilization . It also involves vendor selection, productivity, performance standards,… more
- Elevance Health (Grand Prairie, TX)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with...assessments to identify individual needs and a specific care management plan to address objectives and goals as identified… more
- Houston Methodist (Houston, TX)
- …ascertain case duration timeframes, and respond accordingly. Provides input regarding OR block utilization and management . + Reviews the OR schedule in advance ... departments, vendors, surgeons, anesthesia, and Operating Room (OR) staff, assisting management with the coordination and facilitation of care, process improvement,… more
- Elevance Health (Houston, TX)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements** + Requires ... **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with...assessments to identify individual needs and a specific care management plan to address objectives and goals as identified… more
- HCA Healthcare (San Antonio, TX)
- … Management will be performed. + Prefer at least one year experience in utilization review, resource management , discharge planning or case management . + ... functional and self-care abilities; 2) facilitate system access and appropriate utilization of services; 3) facilitate communication and coordination of efforts… more