- CenterWell (Austin, TX)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... in a high volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a related field + Health… more
- Evolent (Austin, TX)
- …billing and various sites of care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical ... member-centric products. This role plays a critical part in both **Medical Cost Management ** and **Product Management ** , leveraging advanced analytics to solve… more
- Prime Therapeutics (Austin, TX)
- …Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (ie formulary exceptions, prior authorization, step ... for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy,… more
- Evolent (Austin, TX)
- …Oncology is a key clinical executive responsible for leading oncology-related utilization management , quality improvement, and clinical operations across ... cost of oncology care + Lead the development of strategies for care management , utilization mitigation, and value-based incentive programs **Desired Skill Set**… more
- Elevance Health (Grand Prairie, TX)
- …and Experiences:** + Child and Adolescent experience strongly preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... and/or independently performs clinical reviews. + Typically has program management responsibilities including clinical policy development, improvement of quality,… more
- Molina Healthcare (San Antonio, TX)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
- CVS Health (Austin, TX)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + UMNC meets set productivity and ... **Preferred Qualifications** + 1+ years of Managed Care Experience; and experience with utilization review + 1+ years of clinical experience in acute or post-acute… more
- Apex Health Solutions (Houston, TX)
- …and cooperates with internal and external stakeholders. Collaborates effectively with Utilization Management , Quality Management , Pharmacy, Provider ... Summary Responsible for providing case management services and support to improve health outcomes...demonstrate the knowledge and skills necessary to provide care management services appropriate to the member being served. Reports… more
- Select Medical (Denton, 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 Planning + Care Planning Management … more
- Centene Corporation (Austin, TX)
- …+ 7+ years clinical experience in the practice of medicine required. + Management experience preferred. + Utilization Management experience and knowledge ... Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied...sure correct clinical judgment is applied to all medical management determinations. + Provide leadership and expertise in the… more