- Humana (Austin, TX)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Molina Healthcare (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
- Highmark Health (Austin, TX)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… 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
- Evolent (Austin, TX)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Austin, TX)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- HCA Healthcare (Conroe, TX)
- …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Molina Healthcare (San Antonio, TX)
- …contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective quality outcomes ... multi-state region. + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral… more