- Baylor Scott & White Health (Dallas, 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 (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
- MTC (Kyle, TX)
- …Duties:** 1. Performs complex technical assistance work; implements quality assurance utilization review procedures; and responds to inquiries regarding ... technical program and administrative rules, regulations, policies, and procedures. 2. Assists in monitoring, reviewing, interpreting, and evaluating quality of services and success of programs; assists in compiling and analyzing data and preparing reports; and… more
- Deloitte (Dallas, TX)
- …nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and ... health IT preferred + Knowledge of Medicare reimbursement system and coding structures preferred + In-depth knowledge and experience in medical terminology, medical coding, and ICD-10-CM/PCS, IPPS payment system is a plus' + Experience in quality measurement,… more
- CVS Health (Austin, TX)
- …consistent responses to members and providers. You will lead all aspects of utilization review /quality assurance, directing case management. In this role you ... will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities You'll act as lead business and clinical liaison to network providers and facilities to support the effective… more
- MTC (San Diego, TX)
- …Functions:** 1. Performs complex technical assistance work; implements quality assurance utilization review procedures; and responds to inquiries regarding ... technical program and administrative rules, regulations, policies, and procedures. 2. Assists in monitoring, reviewing, interpreting, and evaluating quality of services; assists in compiling and analyzing data and preparing reports; and makes recommendations… more
- Catholic Health Initiatives (Houston, TX)
- …when required, obtaining pre‐certification reference number, approved length of stay, and utilization review company contact person and telephone number. 13. ... Notify hospital Case Managers on all in‐house patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre‐certification. 14. Contact physician's on scheduled patients, to notify them of… more
- Erickson Living (Dallas, TX)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... specific state regulations and requirements may be applicable. These regulations take precedence over the requirements outlined in the job description. Highland Springs is a beautiful 89-acre continuing care retirement community in North Dallas, Texas. We're… more
- MTC (Bryan, TX)
- …disorders. 2. Performs complex technical assistance work; implements quality assurance utilization review procedures; and responds to inquiries regarding ... technical program and administrative rules, regulations, policies, and procedures. 3. Assists in monitoring, reviewing, interpreting, and evaluating quality of services; assists in compiling and analyzing data and preparing reports; and makes recommendations… more
- Baylor Scott & White Health (Mckinney, TX)
- …processes and policies for performance improvement, medical management, quality assessment, utilization review , risk management programs and cost reduction ... measures across Units. **Belonging Statement** We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve. **McKinney, Texas** Just 30 miles north of downtown Dallas,… more