- Sedgwick (Austin, TX)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug… more
- CVS Health (Arlington, TX)
- …Field Experience. + Bilingual. + Crisis intervention skills preferred. + Managed care/ utilization review experience preferred. + Case management and discharge ... and coordination of psycho social wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. **Assessment of… more
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor DME… more
- CVS Health (Austin, TX)
- …Case management and discharge planning experience + Crisis intervention skills + Managed care/ utilization review experience + Ability to take and manage crisis ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... insurance approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay requirements for all patients. +… 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
- Erickson Living (Houston, TX)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... indicators/benchmarking such as Falls, Pressure Ulcers, Medication Errors, Restraint Utilization , Re-hospitalization, Anti-psychotic utilization , ADL splits/documentation, etc.… more
- Highmark Health (Austin, TX)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Elevance Health (Houston, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- HCA Healthcare (Austin, TX)
- …interdepartmental service coordination. + Actively participates in the Performance Improvement and Utilization Review programs. + Assumes a role in the ... improvements in work methods. + Effective in cost control and resource utilization . 9) Key Relationships + Maintains positive relationships with internal customers.… more