- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …The Utilization Management Coordinator will report to the Director of Utilization Review and will be responsible to provide quality case management ... services to all patients and their families, to serve as a member of interdisciplinary team supporting the organization's treatment program and philosophy, and assure the deliverance of quality treatment to patients and their families. Duties: + Assists with… 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
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative I** **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 I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible… more
- Humana (Austin, TX)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- Molina Healthcare (Fort Worth, TX)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all medically necessary prescription… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv. Campus Utilization Mgt (10hr shifts) **Galveston, Texas, United States** Nursing & Care Management UTMB Health ... the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria… more
- Houston Methodist (Houston, TX)
- … of resources. This position is a key member and leader of the hospital's utilization review / management committee, which is charged with regulatory goals of ... care, length of stay, and quality issues. + Chair the utilization review / management committee, actively participates in defining operational strategic… more
- Elevance Health (Grand Prairie, TX)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** Virtual: This role enables associates...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD 10 coding, and… more
- Evolent (Austin, TX)
- …reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews ... Stay for the culture. **What You'll Be Doing:** Clinical Reviewer , Physical Therapy As a Clinical Reviewer ,...Therapy you will be a key member of the utilization management team. We can offer you… more