- 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
- CenterWell (Fort Worth, TX)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization *Monitor and manage daily patient care and initiatives to improve… more
- CenterWell (Arlington, TX)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to align with… more
- Ascension Health (Round Rock, TX)
- …financial departments such as Accounting, Reimbursement, Managed Care, Health Information, and Utilization Review . Reporting directly to the Hospital CEO, the ... stakeholders, including senior leadership, facility staff, and the Ministry Office. + Review denial trends and financial reporting to maximize net reimbursement and… more
- Fedcap (Austin, TX)
- …Attend and participate in ECI team-related quality assurance meetings and reviews including Utilization Review and Peer Review . + Maintain communication ... throughout work hours with the main office. + Conduct intakes and screenings per policies. + Initiate and maintain contact with children's physicians for obtaining and updating necessary medical information. + Serve as a member of a family-centered team to: A.… more
- Insight Global (Houston, TX)
- …to the CMOs. Lead Epic build efforts related to case management and utilization review , including updates driven by Medicare guidelines. Support the upcoming ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Cognizant (Austin, TX)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI… more
- Prime Therapeutics (Austin, TX)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... ranges from $74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page… more
- Adecco US, Inc. (Houston, TX)
- …recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program protocols providing clinical recommendations ... and the 5 Core Elements of MTM Services (1) Medication Therapy Review - Comprehensive and Targeted, 2) Personal Medication List (PML), 3) Medication-Related… more
- HCA Healthcare (El Paso, TX)
- …The Case Manager serves as a liaison between medical staff, administration, utilization review , nursing, finance, medical records and other ancillary departments ... applied data retrieved from the medical record to the review process. Las Palmas Medical Center (https://laspalmasdelsolhealthcare.com/location/las-palmas-medical-center) is a… more