- Abbott (Plano, TX)
- …insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . Some experience in medical device or DME ... insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . + Experience in medical device or DME… 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
- 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
- Baylor Scott & White Health (College Station, TX)
- …coordinating patient care across the continuum to include case management, social work, utilization review and care coordination to achieve optimal clinical and ... FACTORS** Knowledge of Care Coordination, discharge planning, case management and utilization review . Knowledge of human behavior and performance; individual… more
- Baylor Scott & White Health (College Station, TX)
- …coordinating patient care across the continuum to include case management, social work, utilization review and care coordination to achieve optimal clinical and ... FACTORS** Knowledge of care coordination, discharge planning, case management and utilization review . Knowledge of human behavior and performance; individual… more
- Texas Health Resources (Dallas, TX)
- …available resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective ... utilization review according to department identified criteria to determine the appropriate utilization of resources and patient level of care. Reviews daily… more
- Elevance Health (Houston, TX)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and… more
- HCA Healthcare (El Paso, TX)
- …and retrospective review of patient medical records for purposes of utilization review , compliance with requirements of external review agencies ... Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other… more
- MD Anderson Cancer Center (Houston, TX)
- …appeal. * Contact third-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims ... Required: 5 years Experience in clinical nursing and 1 year Experience in utilization review . * May substitute preferred degree for two years of the five… 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