- Houston Methodist (Houston, TX)
- …the leadership team for special project activities related but not limited to, throughput, utilization review and utilization management to align with the ... team members. + Serves as the primary information resource for utilization management staff, payers, physicians, and other health care team members and… more
- UTMB Health (Galveston, TX)
- …the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria ... trends of inappropriate resource utilization to Director/Assistant Director of Utilization Management . + Maintains a documentation system of all review… more
- Molina Healthcare (Houston, TX)
- …and quality initiatives under the direction of leadership. * Monitors drug utilization and assists leadership team in understanding quality and cost-control issues ... pharmacy benefit changes for the upcoming year. * Works with the care management department as part of a member-centered interdisciplinary care team (ICT). * Works… more
- Houston Methodist (Houston, TX)
- … committee, actively participates in defining operational strategic objectives for the Utilization Management Program and serve as the liaison to other ... management committee. Assist with the evaluation of the hospital's Utilization Management Program, including annual review and revision of the hospital's UR… more
- Molina Healthcare (Fort Worth, TX)
- …track general trends in drug utilization and identify potential targeted utilization management activities. * Works with healthcare services team (eg, data ... authorization requests as needed. * Researches, develops, and implements drug utilization and disease state management strategies and intervention techniques… more
- Houston Methodist (Houston, TX)
- …and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the ... At Houston Methodist, the Director Case Management & Social Services RN position is responsible...utilization of resources to avoid denials and resource management as it pertains to delivery of care. **GROWTH/INNOVATION… more
- Evolent (Austin, TX)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Baylor Scott & White Health (Temple, TX)
- …and cost-effectiveness of services provided by the health plan in Utilization Management . Designs and establishes health services policies, methodologies, ... to the role. ESSENTIAL FUNCTIONS OF THE ROLE 1. Directs the Utilization Management department for the BSWH health plan. 2. Recommends and implements strategic… more
- Houston Methodist (Sugar Land, TX)
- …with clinical team partners. This position uses sound clinical judgement in the Utilization Management process and knowledge of regulatory requirements to make ... Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial ...Case Management staff, others as needed and management for data gathering on medical resource utilization… more
- Houston Methodist (Houston, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... is a registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of a targeted patient… more
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