- 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
- 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
- CenterWell (Austin, TX)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… 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
- HCA Healthcare (San Antonio, TX)
- …and actively participating in daily multidisciplinary and bedside rounds, completing drug utilization review to promote rational drug therapy, leading and ... to promote rational drug therapy and make improvements identified by drug utilization evaluations. + You will provide accurate and timely medication information to… more
- HCA Healthcare (San Antonio, TX)
- …and actively participating in daily multidisciplinary and bedside rounds, completing drug utilization review to promote rational drug therapy, leading and ... to promote rational drug therapy and make improvements identified by drug utilization evaluations. + You will provide accurate and timely medication information to… more
- Elevance Health (Grand Prairie, TX)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- Prime Healthcare (Harlingen, TX)
- …to manage care transitions. RN Case Managers also conduct discharge planning, utilization review , and helping patients navigate insurance and healthcare systems. ... including referrals to rehab, home health, or long-term care facilities + Utilization Review : m onitor the use of hospital resources and services to ensure… 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 ... appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant to other areas of… more
- Elevance Health (Grand Prairie, TX)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an ... the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review , drug monographs, and formulary recommendations. + Develop strategies to… more