- Sedgwick (Irving, TX)
- …physician filings and decisions on appropriate treatments recommended by utilization review .** Maintains professional client relationships** **ADDITIONAL ... FUNCTIONS and RESPONSIBILITIES** **Performs other duties as assigned.** **Supports the organization's quality program(s).** **Travels as required.** **QUALIFICATION** **Education & Licensing** **Bachelor's degree from an accredited college or university… more
- Erickson Living (Dallas, TX)
- …of MDS processes, including but not limited to MDS, RAPs, Care Planning, and Utilization Review . + Experience documenting in an Electronic Medical Record (EMR) ... preferred. + Successful completion of AANAC MDS Coordinator Certification. Please note that specific state regulations and requirements may be applicable. These regulations take precedence over the requirements outlined in the job description. Highland Springs… more
- CVS Health (Fort Worth, TX)
- …stability, and administration. + Audits appropriateness of therapy through prospective drug utilization review . + Checks the completion and accuracy of all ... new and refill labels and orders. + Guides pharmacy compliance with all applicable government regulations. + Advises senior management of ongoing issues and drives the development of action plans for issue resolution. + Guides junior colleagues through… more
- CVS Health (Austin, TX)
- …and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination ... reviews and reviews of claim determinations. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide… more
- Baylor Scott & White Health (Plano, TX)
- …needs. + Calculates accurate patient financial responsibility. + Communicates promptly with Utilization Review . Collaborates with the physician and staff to ... ensure financial clearance before the patient's service. + Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits. + Assists co-workers and facility customers with complex questions… more
- Axiom Medical (TX)
- …for quarterly business reviews for all key clients in book of business including utilization review + Forecast and track key account metrics (eg program KPI's, ... quarterly sales results and annual forecasts) Qualifications: The successful candidate should have a combination of demonstrated experience and education that is equivalent to 5 years with a focus on account management or related fields. Physical Requirements:… more
- Sedgwick (Irving, TX)
- …updates or changes with internal departments. + Provides referrals to legal, utilization review , pharmacy, and Special Investigations Unit (SIU) as appropriate ... and coordinates independent medical examinations. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** High school diploma or GED… more
- Sedgwick (Austin, TX)
- …and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred.… more
- Medical Center Hospital (Odessa, TX)
- …of the Trauma patient is required. One year experience in performance improvement, utilization review and teaching is preferred. C. Job Knowledge Comprehensive ... knowledge of professional standards of nursing; Knowledge of accreditation and regulatory agencies' standards and guidelines. Demonstrate by previous experience and accomplishment an ability to apply a broad knowledge base to complex clinical problem solving… more
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in person training ... by law_ **Hours:** Monday - Friday, 8am - 5pm PST The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and… more