• Supervisor, Clinical Pharmacy/MTM - Remote

    Molina Healthcare (Dallas, TX)
    …comply with CMS guidelines. These staff may also be involved in providing utilization management /prior authorization services as needed. * Supervises the unit's ... (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy… more
    Molina Healthcare (08/08/25)
    - Related Jobs
  • Lead Social Worker

    HCA Healthcare (Webster, TX)
    …Social Work Services with experience in health care delivery systems with focus on Utilization Management & Case Management . experience Required Years of ... Qualifications** POSITION SUMMARY: Under the direct supervision of the Case Management Director, collaborates with the Case Managers, Social Workers, hospital… more
    HCA Healthcare (07/30/25)
    - Related Jobs
  • Physician

    MTC (Raymondville, TX)
    …Monitor all potential catastrophic illnesses. 9. Implement basic cost containment and utilization management for patient care and facility operations. 10. Comply ... (EAP)** + **Paid Time Off (PTO)** + **Paid Holidays** **Impact lives with Management & Training Corporation (MTC) at the El Valle Detention Facility in Raymondville,… more
    MTC (07/18/25)
    - Related Jobs
  • Physician

    MTC (Anson, TX)
    …+ Monitor all potential catastrophic illnesses. + Implement basic cost containment and utilization management for patient care and facility operations. + Comply ... + **Paid Time Off (PTO)** + **Paid Holidays** **Looking to impact lives? At Management & Training Corporation (MTC) Medical, our purpose is to help those in need.… more
    MTC (07/09/25)
    - Related Jobs
  • Medical Director, Clinical Services

    Highmark Health (Austin, TX)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
    Highmark Health (07/29/25)
    - Related Jobs
  • Pharmacy Trade Relations Strategy Director…

    Prime Therapeutics (Austin, TX)
    …and works collaboratively with key internal stakeholders including Clinical, Clinical Program Management , and Utilization Management to deliver financial ... cliff opportunities + Serve as interdepartmental bridge between Trade, Clinical Program Management , Clinical, Utilization Management and other stakeholders… more
    Prime Therapeutics (07/22/25)
    - Related Jobs
  • Care Review Clinician, ABA (Licensed Behavior…

    Molina Healthcare (TX)
    …Degree in Behavior Analysis or a related field. **Preferred Experience** Utilization Management experience Health Plan/MCO work experience **Preferred License, ... of stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services to… more
    Molina Healthcare (08/08/25)
    - Related Jobs
  • Medical Director-Medicaid (ABH TX)

    CVS Health (Austin, TX)
    …review, and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and precertification as well ... Independent Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience -Electronic medical… more
    CVS Health (08/08/25)
    - Related Jobs
  • Registered Nurse Case Manager PRN

    HCA Healthcare (Houston, 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
    HCA Healthcare (06/21/25)
    - Related Jobs
  • Registered Nurse Case Manager

    HCA Healthcare (Houston, 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
    HCA Healthcare (06/21/25)
    - Related Jobs