- Baylor Scott & White Health (Waco, TX)
- …or related field preferred. Master's degree preferred. 2. 3+ years of experience in case management, social work, utilization review , or related field. 3. ... function of Baylor Scott and White Health (BSWH), which may include case management, social services, coordination of patient care, patient access, utilization… more
- Elevance Health (Houston, TX)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- HCA Healthcare (Corpus Christi, TX)
- …planning efforts to promote timely and safe discharge from the hospital. The case manager promotes quality care and cost-effective outcomes to enhance the ... code of conduct. 2. Accountable for reviewing, monitoring and reporting hospital utilization of resources through concurrent review according to pre-established… more
- Lumen (Austin, TX)
- …world and shape the future. **The Role** As an Inside Sales Lead Generation Manager you're tasked with leading a group of highly motivated and talented Sales ... the key to success of Lumen. The Lead Generation Manager must be passionate about sales and building a...acquisition and penetration experts + Run weekly dashboards/reports to review with SDR leadership + Provide mentorship and training… more
- Elevance Health (Grand Prairie, TX)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more
- Elevance Health (Houston, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ensuring clinical integrity of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May provide clinical guidance… more
- Veterans Affairs, Veterans Health Administration (Corpus Christi, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants may not apply. Responsibilities ... (LPMHC) is directly responsible to the Recovery Services Program Manager and ultimately to the Chief of Psychology and...and a part of the Veteran's recovery plan. Ensures utilization of government owned equipment (ie, laptop computers, phones,… more
- Houston Methodist (Sugar Land, TX)
- …admissions and avoid inappropriate or unnecessary hospitalizations. + Partner closely with Case Management and Utilization Review to ensure optimal ... best practices. + **Operational Oversight** + Collaborate with the Program Manager , Chief Medical Officer, and other administrative leaders to optimize hospitalist… more
- US Foods (Garland, TX)
- …through the following: consultative services to aid customers through improved utilization of the fresh categories; SOUS training; conducting product demonstrations ... and menu ideas prioritized for top penetration opportunities to achieve Market/Area case growth objectives for category, as well as, realize Exclusive Brand (EB)… more
- Evolent (Austin, TX)
- …Oncology clinical Q&As for provider portal, prior authorizations, lists, regimens, scope diagnoses, case review and related activities. + Review of Carepro ... value- based care and initiatives within pathway, policy, and beyond utilization management solutions. + Introduce innovative initiatives supported with evidence and… more