- Highmark Health (Austin, TX)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
- 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
- Texas Health Resources (Dallas, TX)
- …available resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective ... case management experience is preferred. * RN - Registered Nurse Upon Hire Req or LMSW - Licensed Master...utilization review according to department identified criteria to determine the… 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
- Datavant (Austin, TX)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- Prime Healthcare (Harlingen, TX)
- …to manage care transitions. RN Case Managers also conduct discharge planning, utilization review , and helping patients navigate insurance and healthcare systems. ... Case Manager , also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager ....to rehab, home health, or long-term care facilities + Utilization Review : m onitor the use of… more
- Providence (Plainview, TX)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- Baylor Scott & White Health (Dallas, TX)
- …Master's degree preferred. 2. 5+ years of experience in case management, social work, utilization review , or related field. 3. 1+ years of experience in a ... management, social services, coordination of patient care, patient access, utilization management, and discharge planning. Directs the management and...leadership role preferred. 4. Registered Nurse (RN) or Licensed Master Social Worker (LMSW) or… more
- Houston Methodist (Houston, TX)
- …manner. Takes messages via telephone/email to forward to the provider/registered nurse . + Contributes towards improvement of department scores for employee ... visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. In collaboration with the provider team,… more