- CVS Health (Austin, TX)
- … Organization a Plus **Preferred Qualifications:** -Preferred Oklahoma residency -Health plan/payor Utilization Management / Review experience. -Managed Care ... the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management ) Medical Director will be a...Management , including prior authorization as well as concurrent review . Cases could focus on inpatient or outpatient services,… more
- Texas Health Resources (Arlington, TX)
- …Clinical psychiatric or chemical dependency experience Required and * 6 Months in case management or utilization review Required * Prior experience with EPIC ... and quality of the services provided by the organization are enhanced. Utilization management issues are identified and addressed by the appropriate… more
- Evolent (Austin, TX)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- CVS Health (Austin, TX)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Austin, TX)
- …candidates in compact RN states. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for ... - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...practice experience as an RN - 6+ months Case Management or Utilization Management experience… more
- 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
- MTC (Anson, TX)
- …+ Monitor all potential catastrophic illnesses. + Implement basic cost containment and utilization management for patient care and facility operations. + Comply ... + **Paid Time Off (PTO)** + **Paid Holidays** **Looking to impact lives? At Management & Training Corporation (MTC) Medical, our purpose is to help those in need.… more
- MTC (Raymondville, TX)
- …Monitor all potential catastrophic illnesses. 9. Implement basic cost containment and utilization management for patient care and facility operations. 10. Comply ... (EAP)** + **Paid Time Off (PTO)** + **Paid Holidays** **Impact lives with Management & Training Corporation (MTC) at the El Valle Detention Facility in Raymondville,… more
- Humana (Austin, TX)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- HCA Healthcare (Cypress, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
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