- Humana (Austin, TX)
- …and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy ... maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is...any field or equivalent experience + Active unrestricted Registered Nurse (RN) license + 5 years or more of… more
- Erickson Living (Houston, TX)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... indicators/benchmarking such as Falls, Pressure Ulcers, Medication Errors, Restraint Utilization , Re-hospitalization, Anti-psychotic utilization , ADL splits/documentation, etc.… more
- HCA Healthcare (El Paso, TX)
- …with patients and/or families as needed + You will complete accurate and timely utilization review of patient charts to insure appropriate utilization of ... and referrals **What qualifications you will need:** + Registered Nurse + Bachelors Degree or Licensed Vocational Nurse... Nurse + Bachelors Degree or Licensed Vocational Nurse with clinically focused work history. + 2+ years… 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
- 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
- YesCare Corp (Waxahachie, TX)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. **YesCare Benefits** (only ... and paraprofessional staff. + Ensure and provide on-call services. + Annually review and approve clinical protocols, policies and procedures, and medical disaster… more
- Houston Methodist (Bellaire, TX)
- …level tasks under the direct supervision of a Physician and/or Registered Nurse for assigned patient populations, for providing high quality support of patient ... visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow prior to… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... patients with third-party insurance. Promotes Veteran registration for and utilization of My HealtheVet (MHV); Schedules Veteran appointments with community… more
- System One (Houston, TX)
- …Build out effective Category Strategies by performing analysis on internal utilization , external benchmarking, identify optimized cost models, and develop an ... out and leverage data sources and reports to conduct utilization analysis to monitor and manage spend data within...forecasts to manage ongoing category activities + Conduct ongoing review of market and industry trends to inform category… more
- Molina Healthcare (TX)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... claims data to ensure appropriate payment levels, optimize resource utilization , and maintain compliance with state and federal laws....focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject… more