- CenterWell (Arlington, TX)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... 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… more
- CenterWell (Corpus Christi, TX)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. * Review clinician schedules and incentive plans to align with patient… more
- Molina Healthcare (Fort Worth, TX)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- HCA Healthcare (Dallas, TX)
- …and other parties as appropriate regarding behavioral services** + **Performs utilization review as assigned** + **Participates in developing department ... hours volunteering in our communities. As a(an) Licensed Intake Clinician - PRN with Medical City Green Oaks Hospital...organization. We are looking for an enthusiastic Licensed Intake Clinician - PRN to help us reach our goals.… more
- 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
- Molina Healthcare (TX)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …Administrator and Department Chair, assist with physician productivity and facility utilization . + Regularly review established benchmarks (including but not ... limited to cFTEs) to monitor clinician productivity and make recommendations to the Department Administrator for cFTE or benchmark adjustments. + Participate in … more
- Houston Methodist (Houston, TX)
- …position is a licensed professional Registered Nurse (RN) who, as an experienced clinician , functions at the Competent to Proficient stage of Benner's model of ... in accordance with staffing grid. + Provides input into unit resource utilization including unit capital and operational budget needs. Oversees shift by shift… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Respiratory Services Coordinator position is an advanced clinician who functions within a specific service line patient population or as ... ESSENTIAL FUNCTIONS** + Assists department management in product evaluations and utilization of existing products. Enters charges for services provided, and performs… more
- Catholic Health Initiatives (Houston, TX)
- …LOS, ICU utilization and document variances. + Serve as a clinician in the care of this complex patient population, initiating outpatient appointments and ... to patient advocacy, driving both individual success and program excellence. + Review medical information, schedule testing, review results and compile data… more