- Molina Healthcare (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
- Molina Healthcare (Dallas, TX)
- …retrieving specified information from data sources. + Knowledge of healthcare operations ( utilization management , disease management , HEDIS quality measures, ... and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard… more
- Molina Healthcare (TX)
- …member care. Essential Job Duties * Performs audits of non-clinical staff in utilization management , care management , member assessment, and/or other teams ... * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent combination… more
- Covenant Health (Lubbock, TX)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation ... Nursing within 3 years of hire. + 1 year of experience in care management or utilization review in any setting or successful completion of TIPS program or Case … 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
- Centene Corporation (Austin, TX)
- …ROI evaluation preferred. Familiarity with claims payment, member eligibility, utilization management , provider/vendor contracts, risk adjustment for government ... years of experience in healthcare analytics, large databases, data verification, data management , table creation and indexing, query optimization, utilization of… more
- Danaher Corporation (Dallas, TX)
- …includes some of the following: infection detection/control, sepsis care, decision support, utilization management , case management , ED patient workflow, ... leaders from nursing, emergency medicine, pharmacy, quality, patient safety, risk management , IT, infection control, laboratory, and administration is required. This… 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
- Evolent (Austin, TX)
- …leadership is preferred. + Familiarity with value-based care models and utilization management frameworks is preferred. Technical Requirements: We require ... claims, membership data, and clinical outcomes to uncover cost drivers, utilization trends, and opportunities for integrated care solutions using SAS, SQL,… more
- Molina Healthcare (TX)
- …3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active, ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a...unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more