- Molina Healthcare (Houston, TX)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in the state of Texas. You will be hired to join the inpatient review team doing ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- BAYADA Home Health Care (Austin, TX)
- …your career with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, ... Home Health Care has an immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and… more
- Molina Healthcare (Fort Worth, TX)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more
- UTMB Health (Friendswood, TX)
- …optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, ... **_ESSENTIAL JOB FUNCTIONS_** **:** + Supervises the operational management of the Utilization Review /Case Management program to ensure high quality, cost… more
- Houston Methodist (The Woodlands, TX)
- …resources. This position is a key member and leader of the hospital's utilization review /management committee, which is charged with regulatory goals of ensuring ... of care, length of stay, and quality issues. + Chair the utilization review /management committee, actively participates in defining operational strategic… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Evolent (Austin, TX)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with… more