- 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 (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
- 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
- CVS Health (Austin, TX)
- …Independent Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience -Electronic medical ... review , and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and precertification as well as… more
- HCA Healthcare (Mcallen, 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
- HCA Healthcare (Houston, 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
- Austin Industries (Irving, TX)
- …existing equipment platform and refine and develop and implement new Infrastructure based utilization and management program + Participate in the development of ... **Texas area.** The Equipment Service Manager is responsible for maximizing the utilization of Austin Bridge and Road's equipment across the project spectrum.… more
- Elevance Health (TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written,… more
- Prime Therapeutics (Austin, TX)
- …Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (ie formulary exceptions, prior authorization, step ... for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy,… more
- Molina Healthcare (Austin, TX)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more