- Humana (Austin, TX)
- …and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare) + Proven… more
- System One (Houston, TX)
- …a Category Manager in Houston, TX establish and implement third party Category Management strategies and solutions with the intent to obtain best value in support ... Build out effective Category Strategies by performing analysis on internal utilization , external benchmarking, identify optimized cost models, and develop an… more
- Houston Methodist (Baytown, TX)
- …level tasks under the direct supervision of a Physician and/or Registered Nurse for assigned patient populations, for providing high quality support of patient ... visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow prior to… more
- HCA Healthcare (Georgetown, TX)
- …productivity guidelines for each shift as closely as possible. + You will review and approve employee payroll. Assure that payroll sheets are accurately completed ... assure that documentation in the patient's medical record is accurate and complete. Review records for required documentation. Take action as needed to ensure that… 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 ... claims data to ensure appropriate payment levels, optimize resource utilization , and maintain compliance with state and federal laws....focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject… 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
- Humana (Austin, TX)
- … Review and monitor Contract Change Orders and evaluate impact on Utilization Management processes. Organize and facilitate Change Order workgroup and ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Advise executives… more
- Houston Methodist (Nassau Bay, TX)
- …At Houston Methodist, the Director Nursing position is responsible for the 24/7 management of the assigned nursing units and departments in terms of the quality ... teams to enable the effective and efficient completion of objectives. + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Fresenius Medical Center (Olmito, TX)
- …Preparedness Plan; ensure maintenance of equipment + Ensure proper medical records management and HIPAA compliance + Oversees the continuous and data driven Quality ... and policies, and then developing and implementing an associated center specific management plan. + Ensure adverse events are reported, documented and necessary… more
- Catholic Health Initiatives (Houston, TX)
- …the referral and evaluation process for potential transplant candidates. Review medical information, schedule testing including physician and coordinator ... consultations, collect data, review results and compile data for presentation of patient's...with patients, families and all disciplines involved in patient management in order to streamline post-op course and identify… more