- Prime Healthcare (Weslaco, TX)
- …facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and ... demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Molina Healthcare (Fort Worth, TX)
- …coordination, transitions of care, utilization management (prior-authorization, inpatient review ), behavioral health , long-term services and supports ... the following functions: utilization management, care management, care transitions, behavioral health , long-term services and supports (LTSS), and other… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Molina Healthcare (Fort Worth, TX)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- BrightSpring Health Services (San Antonio, TX)
- Our Company SpringHealth Behavioral Health and Integrated Care Overview Behavior Clinic Supervisor for Youth ABA Line of Business Salary plus incentive bonuses: ... program development + Meet with school districts to provide current information on Spring Health Behavioral Health and Integrated Care Services + Explore… more
- Elevance Health (Grand Prairie, TX)
- …clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical ... state or territory of the United States when conducting utilization review or an appeals consideration and...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Veterans Affairs, Veterans Health Administration (Temple, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... and interactional patterns within the client system. This includes the utilization of testing measures where appropriate. -Provides counseling and/or psychotherapy… more
- Molina Healthcare (Austin, TX)
- …management, care review , utilization management, transitions of care, behavioral health , long-term services and supports (LTSS), and/or other program ... within Molina's clinical/healthcare services function, which may include care review , care management, and/or correspondence processing, etc. * Researches and… more
- Highmark Health (Austin, TX)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member… more
- HCA Healthcare (Corpus Christi, TX)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical ... guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality… more