- 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
- 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
- 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