- Humana (Austin, TX)
- …during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare) + Proven… more
- Fortive Corporation (Fort Worth, TX)
- …and local Integrated Delivery Networks (IDN), including the following: Supply Chain, Nurse Managers, Risk Management , and Sterile Processing, Materials ... positive Customer experiences. + Drive market share through existing customer utilization assessments and contending for new footprint expansion while developing… more
- BrightSpring Health Services (Houston, TX)
- …Works with nursing personnel on survey preparation/ chart reviews/staffing concerns/ED utilization and hospital admission reduction.* Provides survey management ... health services. Provides oversight for health and safety, survey management , incident management , MAR/EHR applications, training and...driving improvement in performance.* Ensures that there is a nurse on call after hours for all homes (and… more
- Catholic Health Initiatives (Pasadena, TX)
- …employees. 6.Has an identified council structure with an elected Staff Nurse Professional Practice Council representative. Conducts unit council meetings monthly ... programs. 20. Demonstrates accountability for human and material resource management with division guidelines and standards by monitoring, correcting variances… more
- Molina Healthcare (Fort Worth, TX)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Pre-Transplant Coordinator position a registered nurse , responsible for participating in department initiatives, facilitating, and ... complex patients, receiving coaching from experienced Transplant Coordinators and management , benefiting from their practice. The Pre-Transplant Coordinator position… more
- Molina Healthcare (TX)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... bills, and claims data to ensure appropriate payment levels, optimize resource utilization , and maintain compliance with state and federal laws. All reviews must… more
- Houston Methodist (Houston, TX)
- …in a hospital setting + Two years of experience in Hospital Quality Improvement, Case Management or Utilization Management role preferred + Two years of ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure...Licensure within 60 days **OR** + RN-Temp - Registered Nurse - Temporary State Licensure within 60 days **LICENSES… more
- UTMB Health (Tennessee Colony, TX)
- …information and records at all times. + Practices basic cost containment and utilization management for patient care and facility operations. + Prioritizes and ... patient activities and care as assigned by the charge nurse /designee as indicated by the patient's plan of care....extended or alternate shifts in situations deemed necessary by nurse manager. + Able to work under stress and… more
- Community Health Systems (Laredo, TX)
- …huddles. + Monitors patient flow, manages bed assignments, and optimizes resource utilization within the unit. + Conducts employee and patient rounding to evaluate ... are available and properly utilized while maintaining cost-effective resource management . + Facilitates ongoing education and professional development for nursing… more