- Baylor Scott & White Health (Dallas, TX)
- …or related field preferred. Master's degree preferred. 2. 5+ years of experience in case management , social work, utilization review , or related field. 3. 1+ ... , social services, coordination of patient care, patient access, utilization management , and discharge planning. Directs the...of experience in a leadership role preferred. 4. Registered Nurse (RN) or Licensed Master Social Worker (LMSW) or… more
- Molina Healthcare (Fort Worth, TX)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- CVS Health (Austin, TX)
- …management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases ... all with heart, each and every day. **Position Summary** The Care Management Associate (CMA) supports comprehensive coordination of medical services that include… more
- Molina Healthcare (San Antonio, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Molina Healthcare (Fort Worth, TX)
- …including care management , care coordination, transitions of care, utilization management (prior-authorization, inpatient review ), behavioral health, ... professionals, in some or all of the following functions: utilization management , care management , care...and experience. * At least 7 years health care management /leadership experience. * Registered Nurse (RN), Licensed… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service… more
- Elevance Health (Houston, TX)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- CenterWell (Austin, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay… more
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