- CenterWell (Eastland, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care ... patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use,… more
- Molina Healthcare (Fort Worth, TX)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of… more
- HCA Healthcare (San Antonio, TX)
- …clinicians regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist) to ensure the medical records reflect compliance with medical ... necessity, homebound status, visit utilization , and documentation of individualized patient assessment and transition...Two years of experience within a licensed and certified ( Medicare ) home health agency requiredCompetent in Federal ( Medicare… more
- HCA Healthcare (San Antonio, TX)
- …and accepted internal (eg unit, department, and hospital) and external (eg JCAHO, Medicare , OSHA) standards in order to facilitate optimum care and health education ... for patients and appropriate utilization of resources which support daily operation in his/her...data in his/her areas. 3. Works cooperatively with the Nurse Administrators/ Nurse Managers to communicate daily issues… more
- Humana (Austin, TX)
- …involvement in day-to-day UM activities and discussions with UM leaders. 20% 2. Review and monitor Contract Change Orders and evaluate impact on Utilization ... **Use your skills to make an impact** **Required Qualifications** + **Registered Nurse (RN)** **with current, unrestricted licensure** + BSN or degree in related… more
- HCA Healthcare (Jourdanton, TX)
- …appropriate prescribing, route, method of administration, and length of therapy; includes review of allergy history on all patients and weight for weight-based ... all follow-up actions as needed to include timely notification of physician and nurse . 3. Provides continual guidance to technical staff as it applies to performance… more
- Fresenius Medical Center (Olmito, TX)
- …state regulations, and accrediting agency standards where applicable. + Participate in review business and finances of the site, including financial reports, market ... the security and integrity of facility + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve supply… more