- HCA Healthcare (Cypress, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
- AON (Houston, TX)
- …and ability to work with others. + Experience in resource deployment and utilization management . + Successfully operates in a fast-paced driven environment that ... to work with others. + Experience in resource deployment and utilization management . + Successfully operates in a fast-paced driven environment that requires… more
- Humana (Austin, TX)
- …+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard ... Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization,… more
- Austin Industries (Irving, TX)
- …existing equipment platform and refine and develop and implement new Infrastructure based utilization and management program + Participate in the development of ... **Texas area.** The Equipment Service Manager is responsible for maximizing the utilization of Austin Bridge and Road's equipment across the project spectrum.… more
- Humana (Austin, TX)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Highmark Health (Austin, TX)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... data-driven insights from complex healthcare datasets (eg, claims, clinical, utilization , pharmaceutical) to inform policy development, identify areas for… more
- Children's Home Healthcare (Amarillo, TX)
- …have excellent communication skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for patient visits + ... for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional Services.… more
- Highmark Health (Austin, TX)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Prime Therapeutics (Austin, TX)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... cost solutions that meet the desired outcomes of the customer; general management of the account, including P&L responsibility; and accountability for contract… more
- CVS Health (Austin, TX)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the… more