- CVS Health (Austin, TX)
- … Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience -Electronic medical systems/record ... and consistent responses to members and providers related to precertification, concurrent review , and appeal request. This position is primarily responsible for … more
- AdventHealth (Burleson, TX)
- …AND EXPERIENCE PREFERRED:_** 2-3 years in hospital quality, case management, utilization review , or performance improvement. Strong understanding of hospital ... winning facility and departments including Great Place to Work by Beckers Hospital Review and Gallup. + Work with the latest technology and top experts including… more
- Houston Methodist (Katy, TX)
- …Audit, Business Practices, Health Information Management, Patient Access Services, and Utilization Review as needed to ensure operational billing compliance ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Elevance Health (Grand Prairie, 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 ... for Medicare fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor (MAC) Medical Directors… more
- HCA Healthcare (Austin, TX)
- …and retrospective review of patient medical records for purposes of utilization review , care coordination compliance with requirements of external review ... to apply for our NICU Case Manager Austin Market Float Pool PRN opening. We review all applications. Qualified candidates will be contacted by a member of our team.… more
- CVS Health (Austin, TX)
- …Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual ... Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for medical necessity ...based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols. + Serve… more
- Molina Healthcare (Houston, TX)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...also entails producing audit reports for internal and external review . The position may also work with other internal… more
- Baylor Scott & White Health (Dallas, TX)
- …Specialists. Promotes related education to allied health professionals, Administration, Utilization Review , and Comprehensive Care. Focuses on documentation's ... medical conditions and treatment in patient records. + Performs review of record to establish complete, accurate documentation of...CDI experience. + HIM: 4 years of medical record review experience in inpatient coding/auditing or Quality, or Case… more
- The Hartford (San Antonio, TX)
- …Understanding of PPD rules and requirements, claim management, case management, and/or utilization review methodology preferred + Excellent verbal and written ... the PPD Clinical Consultant will apply his/her medical expertise to review impairment ratings utilizing AMA and state-specific software supported guidelines. The… more
- HCA Healthcare (Houston, TX)
- …responsibility typically includes Accounting, Reimbursement, Managed Care, Health Information, and Utilization Review . Functions at an executive level in an ... administration, appropriate facility staff members and Division Office. + You will review denials issues and trends for maximizing net reimbursement for Facility.… more