- HCA Healthcare (Tomball, 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
- Ascendis Pharma (TX)
- …Institute for Clinical and Economic Review (ICER) and state Drug Utilization Review Boards (DURBs)). HCP Relationship Management + Through appropriate ... and initiates and manages collaborative external and/or internal projects upon alignment, review and approval + Participates on internal project teams as directed by… 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 ... agencies including government and non-governmental payers and quality assurance. Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physician; funding representatives and community agencies. Ensure continuity… more
- UTMB Health (Galveston, TX)
- …standards + Participate in clinical quality improvement initiatives and utilization review activities **Educational Responsibilities** + Supervise and ... departmental, institutional, or professional committees + Contribute to peer review , credentialing, and clinical pathway development + Support recruitment,… more
- HCA Healthcare (Corpus Christi, TX)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... to apply for our Mental Health Prof II Mast PRN opening. We review all applications. Qualified candidates will be contacted for interviews. **Unlock the… more
- Elara Caring (Conroe, TX)
- …Identifies and reports potential payment/coverage problems. + Supervises and coordinates utilization review activities. + Participates in strategic development ... of Key Accounts, including participation in weekly, monthly, and quarterly review meetings, as needed. + Ensures accuracy of all public information, materials, and… more
- Baylor Scott & White Health (Austin, TX)
- …needs. Calculates accurate patient financial responsibility. Communicates timely with Utilization Review , and collaborates effectively with physician and ... facility staff to ensure financial clearance of the patient?s account prior to scheduled or unscheduled service during the patient?s hosptial stay. Interprets complex payer coverage information including, but not limited to, network participation status with… more
- CVS Health (La Feria, TX)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients' prescriptions are filled promptly, safely, and accurately, and we are providing caring service that… more
- CVS Health (Austin, TX)
- …Advanced digital literacy skills **Preferred Qualifications** + Pharmacy knowledge, drug utilization review , excellent consultation skills with patients, strong ... customer service skills. + PC literate, solid writing skills, knowledge of pharmacy laws, and accurate clinical information. + Excellent communication skills. + Ability to learn new operating systems and new communication strategies. + Must be flexible,… more
- CVS Health (Austin, TX)
- …and the dedicated Account Team & Employer. In addition, you will oversee utilization review /quality assurance, and provide clinical guidance to support case ... management activity. In this role you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. You will also act as a lead business and clinical liaison to account teams… more