- CVS Health (Austin, TX)
- …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... Multiple state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan… more
- Baylor Scott & White Health (College Station, TX)
- …for assessing and coordinating patient care across the continuum to include case management , social work, utilization review and care coordination to ... resolution **KEY SUCCESS FACTORS** Knowledge of Care Coordination, discharge planning, case management and utilization review . Knowledge of human behavior… more
- Baylor Scott & White Health (College Station, TX)
- …for assessing and coordinating patient care across the continuum to include case management , social work, utilization review and care coordination to ... of services. **KEY SUCCESS FACTORS** Knowledge of care coordination, discharge planning, case management and utilization review . Knowledge of human behavior… more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay… more
- Highmark Health (Austin, TX)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- HCA Healthcare (El Paso, TX)
- …of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other clinical ... review of patient medical records for purposes of utilization review , compliance with requirements of external...setting with recent work history in acute care case management role or related health care experience. Working knowledge… more
- HCA Healthcare (San Antonio, TX)
- …and actively participating in daily multidisciplinary and bedside rounds, completing drug utilization review to promote rational drug therapy, leading and ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...rational drug therapy and make improvements identified by drug utilization evaluations. + You will provide accurate and timely… more
- HCA Healthcare (El Paso, TX)
- …of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other clinical ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...review of patient medical records for purposes of utilization review , compliance with requirements of external… more
- CenterWell (Corpus Christi, TX)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- HCA Healthcare (El Paso, TX)
- …of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other clinical ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...review of patient medical records for purposes of utilization review , compliance with requirements of external… more