- Evolent (Austin, TX)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- Molina Healthcare (San Antonio, TX)
- …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Cognizant (Austin, TX)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals… more
- Houston Methodist (Sugar Land, TX)
- …performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical ... team partners. This position uses sound clinical judgement in the Utilization Management process and knowledge of regulatory requirements to make appropriate… more
- Houston Methodist (Houston, TX)
- …improvements as needed. + Collaborates with HMCPA on care transition and utilization management initiatives. + Provides strategic vision and execution for ... for providing executive leadership and strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across… more
- Molina Healthcare (TX)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Texas Health Resources (Arlington, TX)
- …and quality of the services provided by the organization are enhanced. Utilization management issues are identified and addressed by the appropriate ... are reported to supervisor and Administrative leaders as appropriate. Potential utilization management issues are addressed with supervisor and administration… more
- Elevance Health (Houston, TX)
- **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Texas Health Resources (Arlington, TX)
- …and methods necessary for a high-performance culture related to care transition management . Utilizes change management techniques to facilitate leader and staff ... of policies, procedures, and standards that provide structure for care transition management . Participates in the development of new staffing and care coordination… more
- Texas Health Resources (Frisco, TX)
- …methods necessary for a high performance culture related to care transition management . Supports change management and movement toward interaction with ... of policies, procedures, and standards that provide structure for care transition management . Participates in the development of new staffing and care designs that… more
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