- Evolent (Austin, TX)
- …review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician reviewer for oncology cases that do not initially meet medical necessity… more
- MTC (Raymondville, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are...with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is… more
- Prime Therapeutics (Austin, TX)
- …specific clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products ... stakeholders through effective consultative services. **Responsibilities** + Coordinate formulary management for the client including, client specific Pharmacy &Therapeutics… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... in the FPPE/OPPE process. Adhere to employee health requirements. Participate in peer review process. Time/Leave Management : Adhere to tour of duty. Timely… more
- Texas Health Resources (Dallas, TX)
- …all available resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective ... Preferred * Three years' clinical experience required. * One year of hospital case management experience is preferred. * RN - Registered Nurse Upon Hire Req or LMSW… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....degree such as nursing, social work, psychology, health information management or other related healthcare field is preferred or… more
- Wolters Kluwer (Coppell, TX)
- …customer relationships to retain and grow existing commercial customer base + Review account utilization management reporting and provide recommendations ... The Sr. Strategic Account & Relationship Management Executive will be responsible for managing and...product value proposition and solution design + Develop and review implementation scope + Coordinate with Sales Operations team… more
- Elevance Health (Grand Prairie, TX)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses appropriate screening… 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 ... complete application has been submitted on our career site. We will review your interest but recommend to apply at houstonmethodistcareers.org **Company Profile:**… more
- Highmark Health (Austin, TX)
- …expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify ... by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the incumbent participates in various… more