- South Plains Rehabilitation Hospital, an affiliate of UMC… (Brownfield, TX)
- …timely procuring/planning of resources to avoid discharge delays or issues. Participate in utilization review process: data collection, trend review , and ... Maintain knowledge of regulations/standards, company policies/procedures, and department operations. Review /analyze case management reports, including Key Care Indicators, and… more
- BHS Network TX (Harlingen, TX)
- …and staffing Assists the physician as follows, but not limited to Utilization Review , Quality Assurance, Program Evaluation, Infection Control, Safety Committee ... activities Adhere to the established policies and procedures of Tenet Physician Resources Orders and interprets the results of laboratory tests as part of the physical examination and health management. Perform and oversee testing and other appropriate… more
- Novo Nordisk Inc. (San Antonio, TX)
- …providers and IHNs; c) develops appropriate use of NNI products and greater utilization of its services d) supports and assists representatives and managers in ... sites; ensuring effective coordination and facilitation of studies to ensure timely review , initiation, and completion, as well as publication of study results.… more
- Molina Healthcare (Austin, TX)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Christus Health (San Antonio, TX)
- …Medicare GMLOS by managing per Milliman/Interqual Care Guidelines. Resource/ Utilization Management/appropriateness: Assess assigned patient population for medical ... Proactively refers cases to physician adviser for P2P, medical necessity review , and denail avoidance. Demonstrates and maintains current knowledge of regulatory… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management,… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center **Webster, Texas, United States** Nursing & Care Management UTMB Health Requisition # 2506588 The mission ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- Baylor Scott & White Health (Dallas, TX)
- **JOB SUMMARY** The Utilization Review Registered Nurse (RN) provides a clinical review of cases using medical necessity criteria to determine the medical ... outpatients) or type of service. Alerts and collaborates with appropriate Utilization Review , Physician leadership and/or Provider Team personnel concerning… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician Advisors. + Qualifications: A. Education: Holds a current Texas license as a… more
