- Houston Methodist (The Woodlands, 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
- Houston Methodist (Cypress, 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
- Molina Healthcare (Fort Worth, TX)
- …and/or Tableau and data management + Knowledge of healthcare operations ( utilization management , disease management , HEDIS quality measures, claims ... and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports… more
- Elevance Health (Grand Prairie, TX)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... Current unrestricted RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health… more
- Molina Healthcare (Austin, TX)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… more
- Evolent (Austin, TX)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Houston Methodist (The Woodlands, 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
- Evolent (Austin, TX)
- …health) + Previous experience in a medical economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of ... healthcare underwriting methodologies + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking… more
- Elevance Health (Corpus Christi, TX)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... integrated care plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as… more
- CVS Health (Austin, TX)
- …plan medical directors. + Attend and participate in clinical meetings with care management and utilization management . Provide subject matter expertise on ... the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual Aetna member… more