- Elevance Health (Houston, 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 ... ** Behavioral Health Medical** **Director-Psychiatrist** **Appeals** **Location:** This role...and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis… more
- Molina Healthcare (Austin, TX)
- …healthcare services activities for care management , care review , utilization management , transitions of care, behavioral health, long-term services ... members within Molina's clinical/healthcare services function, which may include care review , care management , and/or correspondence processing, etc. *… more
- Molina Healthcare (Fort Worth, TX)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Safran (Gainesville, TX)
- …accordance with the defining processes. The role does not involve the direct management of other employees, primarily it involves the effective independent review ... necessary, must be ready to explain those findings to management as part of the process to agree to...of new product/feature development). B) Act as an independent reviewer of both Master Engineering Reviews and Part Design… more
- Highmark Health (Austin, TX)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- HCA Healthcare (Austin, TX)
- …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Georgetown Behavioral Health Institute (Georgetown, TX)
- …system and treatment methods, with specific knowledge and skills in areas of risk management , infection control, and utilization review ; strong oral and ... The Director of PI & Risk Management is responsible for the development, planning, coordination...responsible for developing, implementing and monitoring of a quality review program. The essential duties of the Director of… more
- Highmark Health (Austin, TX)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Highmark Health (Austin, TX)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding,...in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the… more
- CenterWell (Austin, TX)
- …of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care received by members in an assigned region, ... practice management . + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid, or… more