- Molina Healthcare (TX)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
- Molina Healthcare (TX)
- …weekly/monthly/quarterly/annually standard reports. + Must have experience in analyzing Utilization management , member health risk assessment data using ... PowerBI + Must be able to collaborate with Executive teams in Utilization management , Operations, Core EIM teams. **JOB QUALIFICATIONS** **Required Education**… 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)
- …public plans such as Medicaid is preferred. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman) is ... visualization, this role will collaborate cross-functionally to influence the effective utilization of data to deliver actionable insights, drive recommendations and… 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
- Baylor Scott & White Health (Austin, TX)
- …patterns to key stakeholders. This will include close partnership with the BSWH utilization management function to gather information and resolve issues with ... BSWH overall business objectives. + Directs daily operations of clinical denial management , including the development and implementation of utilization policies,… more
- Houston Methodist (Houston, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service… more
- Houston Methodist (Nassau Bay, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position… more