- Healthfirst (TX)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, ... and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services and optimal… more
- CVS Health (Austin, TX)
- …o Consulting with and recommending standard and custom formulary options and utilization management edits. o Collaborating with internal partners to develop ... value and drives lowest net cost. o Consulting with and recommending utilization management programs or other clinical programs to a client. o Consulting with… more
- Centene Corporation (San Antonio, TX)
- …or medical group experience, provider relations, quality improvement, claims, contracting utilization management , or clinical operations. Project management ... align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in… more
- Actalent (Dallas, TX)
- Clinical Review Nurse ( Utilization Management )100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent ... and appropriate setting of care. Essential Skills + 2+ years of utilization management and utilization review expertise. + Experience in concurrent review… more
- Evolent (Austin, TX)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Evolent (Austin, TX)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. .… more
- Humana (Austin, TX)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Austin, TX)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Evolent (Austin, TX)
- …insights to internal and external stakeholders. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman). ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
- Humana (Austin, TX)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more