- Molina Healthcare (Fort Worth, TX)
- JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... * Provides telephone, clerical and data entry support for the care review team. * Provides computer entries of authorization request/provider inquiries, such as… more
- Apex Health Solutions (Houston, TX)
- …and cooperates with internal and external stakeholders. Collaborates effectively with Utilization Management , Quality Management , Pharmacy, Provider ... Summary Responsible for providing case management services and support to improve health outcomes...and adherence to established plan of care. Provides medication management support, including comprehensive medication review and… more
- Centene Corporation (Austin, TX)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Travelers Insurance Company (Austin, TX)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
- Centene Corporation (Austin, TX)
- …+ 7+ years clinical experience in the practice of medicine required. + Management experience preferred. + Utilization Management experience and knowledge ... community, including periodic consultation with providers or prescribers. + Review case management data, identifies trends and gaps in care and recommends… more
- HCA Healthcare (Houston, TX)
- …planning, implementation and overall evaluation of individual patient needs. Care coordination, utilization review and management , as well as discharge ... years recent acute care experience required. Minimum of two (2) years of utilization review /case management experience and minimum of one (1) year experience… more
- Molina Healthcare (Austin, TX)
- …file review standards and surveyor interactions. + Experience with conducting Utilization Management and Population Health Management file audits, ... system analysis and program staff. These positions' primary focus is project/program management . **Job Duties** **Program Oversight & Project Management ** +… more
- Houston Methodist (Houston, TX)
- …in a hospital setting + Two years of experience in Hospital Quality Improvement, Case Management or Utilization Management role preferred + Two years of ... Conducts record review for performance improvement, peer review , patient safety, risk management and other projects. + Facilitates and leads process and… more
- MTC (Livingston, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... plan **Make a Difference Where It Matters!** Operated by Management & Training Corporation, the **IAH Detention Facility in...of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are… more
- Prime Therapeutics (Austin, TX)
- …formularies, including items such as manufacturer and GPO negotiation, rate and utilization management policy creation and interpretation, formulary modeling and ... internal and external stakeholders. This position is also responsible for the management of the Trade Client Strategy government programs team, which is responsible… more