- Molina Healthcare (Houston, TX)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- HCA Healthcare (Plano, TX)
- …about delivering patient-centered care?** Submit your application for Operating Room Registered Nurse position and spend more time at the bedside with the patient. ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Surgery Center of Plano! **Job… more
- MTC (Livingston, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... plan **Make a Difference Where It Matters!** Operated by Management & Training Corporation, the **IAH Detention Facility in...has a unique and rewarding challenge for a dedicated nurse . Help us provide essential care where your expertise… more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Fresenius Medical Center (Paris, TX)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- MTC (Raymondville, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are...with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is… more
- AdventHealth (Mansfield, TX)
- …oversight to assure capital and fiscal accountability. + Partners with Utilization Management for the Utilization Review Committee as well as day-to-day ... career with AdventHealth, named in 2018 by Beckers Hospital Review as one of the 150 Top Places to...above) in addition to 5 years of direct care management / utilization management experience and increasing… more
- Fresenius Medical Center (Tyler, TX)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... clinical nursing/patient care experience which includes three years in utilization review , case management or...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more