- CVS Health (Austin, TX)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient Clinical ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external… more
- 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
- 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
- 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
- Molina Healthcare (Fort Worth, TX)
- …holidays.** Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
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