- Actalent (Houston, TX)
- …ensure the successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization, utilization ... planning. + Proficiency with InterQual. + Active Compact RN License. + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong… more
- Evolent (Austin, TX)
- …Doing:** As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews charts… more
- Molina Healthcare (Fort Worth, TX)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Molina Healthcare (TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… 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
- CVS Health (Austin, TX)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… more
- CVS Health (Austin, TX)
- …compact Registered Nurse (RN) states. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible ... Nurse (RN) + 2+ years' experience in critical care + 6+ months case management or utilization management experience + Must be able to work Monday - Friday… more
- ChenMed (Houston, TX)
- …in conjunction with the transitional care team; hospital, SNF, post-acute, delegated utilization management and home-based services for the market. + Performs ... plan of care, providing health education, specialty referrals and case management referrals, providing follow-up care and applying clear, in-depth documentation… more
- Highmark Health (Austin, TX)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files,… more
- Select Medical (Frisco, TX)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... of the discharge planning process. **The primary job functions in Case Management include:** + Clinical Interventions/Discharge and Care Planning Management +… more