- Molina Healthcare (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
- 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 ... state(s) required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9 and CPT-4… 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 (Houston, 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
- CVS Health (Austin, TX)
- …role that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management ) Medical Director will be a "Work from Home" position ... concurrent review, and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well as concurrent… more
- Centene Corporation (Austin, TX)
- …strategic and clinical leadership for Behavioral Health across all clinical functions ( Utilization Management , Care Management , Quality, and Clinical ... for the product. + Take a macro-level view of behavioral health utilization management responsibilities to optimize clinical resource allocation and improve… more
- Danaher Corporation (Houston, 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
- Molina Healthcare (Fort Worth, TX)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Health Care Service Corporation (Richardson, TX)
- …not required to obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience **Telecommute:** ... reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care. **JOB REQUIREMENTS** **:** + LPN with… more
- Highmark Health (Austin, TX)
- …of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management ... experience in a supervisory capacity or role **Preferred** + Experience in Utilization Management and/or Medical PolicyExperience working with claims data… more