- Molina Healthcare (Houston, TX)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Elevance Health (Grand Prairie, TX)
- …with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education ... granted as required by law._ This role's primary focus is ABA utilization management The **Manager Behavioral Health Services** is responsible for Behavioral Health… more
- Molina Healthcare (Houston, TX)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the unit's… more
- Evolent (Austin, TX)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
- Molina Healthcare (Fort Worth, TX)
- …that support one or more of the following activities: care review/ utilization management ( prior authorizations, inpatient/outpatient medical necessity, etc.), ... of healthcare or health plan supervisory experience. Managed Care operations experience. Prior Medical Assistant experience. To all current Molina employees: If you… more
- CVS Health (Austin, TX)
- …review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well ... - Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. - Prior UM experience working at Health Plan / Insurer or experience… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Utilization Management Registered Nurse delivers fundamental knowledge-based care to assigned clients while developing technical skills. ... (To include but not limited to): The Registered Nurse Utilization Management Registered Nurse is focused on individual growth...subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Quality & Patient Safety Nurse Manager - Utilization Management functions as a clinical expert and is responsible and accountable for ... designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment… more
- Molina Healthcare (Fort Worth, TX)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... and quality initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and cost control issues… more
- Molina Healthcare (Austin, TX)
- …Nursing **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests… more
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