- RxBenefits (Houston, TX)
- …channel management , B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, ... prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical...closed won groups into a client record for Account Management (AM) and Implementation including the initial gathering of… more
- Evolent (Austin, TX)
- …**What You'll Be Doing:** As a FMD, Radiology 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
- Evolent (Austin, TX)
- …Doing:** As a Field Medical Director, Oncology, 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
- Texas Health Resources (Plano, TX)
- …also providing quality medical care. 5. Support effective patient throughput, utilization management , and compliant documentation. MEDICAL STAFF GOVERNANCE: 1. ... Credentials Committee to coordinate medical staff credentialing including the review of credentials, delineation of clinical privileges, development of privileges,… more
- Ascension Health (Austin, TX)
- …setting (Adult Medicine Hospitialist experience preferred), preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to ... of physicians apply today! **Responsibilities:** Work in areas of utilization management and denial mitigation, including but...and denial mitigation, including but not limited to: + Review medical records of identified patients to assist with… more
- Molina Healthcare (San Antonio, TX)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Humana (Austin, TX)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... 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 (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position… more
- Molina Healthcare (San Antonio, TX)
- …room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Evolent (Austin, TX)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more