- Defense Health Agency (San Antonio, TX)
- …Department or Hospital board or committee meetings. Participates in the clinic Utilization Management and Quality Assurance processes. Attends Continuing Medical ... objectives. The incumbent exercises independent judgment in the medical treatment and management of patients and Internal Medicine Clinic (IMC) with the full range… more
- HCA Healthcare - Chief Medical Officer (San Antonio, TX)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
- Fresenius Medical Care (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
- UTMB Health (Galveston, TX)
- …to budget planning, fiscal and resource planning/administration, human resource utilization , policy administration, and coordination and negotiation of activities ... followed accordingly with regard to faculty appointments, promotions, and tenure review . Identifies and adheres to appropriate internal controls for department and… more
- CVS Health (Austin, TX)
- …+ Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation ... efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can ... department.** **Rotational late shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to… more
- Humana (Austin, TX)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles… more
- Cognizant (Austin, TX)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
