- Molina Healthcare (San Antonio, TX)
- **Knowledge/Skills/Abilities** + Perform research and analysis of complex healthcare utilization and performance date, claims data, pharmacy data, and lab data ... regarding utilization and cost containment information. + Evaluate, write, and...cost containment information. + Evaluate, write, and present healthcare utilization and cost containment reports and makes recommendations based… more
- UTMB Health (Friendswood, TX)
- …of new personnel and completes a formal preceptor plan in accordance with Utilization Management Policy 09.04. + Identifies and facilitates quality improvement ... optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/Case Management program by utilizing clinical knowledge,… 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
- 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 (The Woodlands, 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)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- CommonSpirit Health (Houston, TX)
- …position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level of… more
- Evolent (Austin, TX)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Wolters Kluwer (Dallas, TX)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + Ongoing Utilization Management + Oversee and analyze customer utilization ... plays a high-impact role in managing strategy and product utilization across the CDSP product portfolio. They serve as...exceeded and that renewals are achieved. + Customer Relationship Management + Partner with Sales to build and maintain… more
- Molina Healthcare (Austin, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more