• Medical Director Aetna Duals Center of Excellence

    CVS Health (Austin, TX)
    …Michigan, Virginia, Pennsylvania, and New Jersey** offering a variety of physical and behavioral health programs and services to its membership. Aetna is looking ... we have an Integrated plan. Experience with managed care (Medicare and Medicaid) utilization review preferred. **Education** MD (Doctor of Medicine) or DO… more
    CVS Health (11/13/25)
    - Related Jobs

  • Senior Decision Support Consultant

    Highmark Health (Austin, TX)
    …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
    Highmark Health (11/14/25)
    - Related Jobs

  • Supv Comprehensive Care RN

    Baylor Scott & White Health (College Station, TX)
    …coordinating patient care across the continuum to include case management, social work, utilization review and care coordination to achieve optimal clinical and ... FACTORS** Knowledge of Care Coordination, discharge planning, case management and utilization review . Knowledge of human behavior and performance; individual… more
    Baylor Scott & White Health (10/25/25)
    - Related Jobs

  • Supv Comprehensive Care SW

    Baylor Scott & White Health (College Station, TX)
    …coordinating patient care across the continuum to include case management, social work, utilization review and care coordination to achieve optimal clinical and ... FACTORS** Knowledge of care coordination, discharge planning, case management and utilization review . Knowledge of human behavior and performance; individual… more
    Baylor Scott & White Health (10/25/25)
    - Related Jobs

  • Payment Integrity Clinician

    Highmark Health (Austin, TX)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
    - Related Jobs

  • Mental Health Prof II

    HCA Healthcare (San Antonio, TX)
    …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... + Participates in developing department goals/objectives and clinical programming. Performs utilization review as assigned. + Assists with Process and… more
    HCA Healthcare (11/21/25)
    - Related Jobs

  • Medical Director, Medical Management

    Highmark Health (Austin, TX)
    …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
    Highmark Health (11/21/25)
    - Related Jobs

  • Dental Network Service Representative

    Highmark Health (Austin, TX)
    …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
    Highmark Health (11/14/25)
    - Related Jobs

  • Chief Medical Officer

    HCA Healthcare (Austin, TX)
    …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...of quality and cost improvement and develops systems to review utilization of resources and objectively measure… more
    HCA Healthcare (11/07/25)
    - Related Jobs

  • Medical Director

    Elevance Health (TX)
    …law._ The **Medical Director** is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. + Identifies and...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (11/15/25)
    - Related Jobs