- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...and management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as,… more
- HCA Healthcare (Houston, TX)
- …and Medical Staff with referral of all cases in question to the Utilization Management Physician Advisor. + Communicates with third party payers regarding ... in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved...ancillary staff on individual nursing units to promote ongoing review of patient care activities related to provision of… 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
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor DME… more
- Houston Methodist (Houston, TX)
- …data management support to the department staff to facilitate efficient utilization of resources including referrals management, communication and collaboration with ... performs duties including but not limited to coordinating needed physician referrals and appointments, assisting with department initiatives, demonstrating… more
- CenterWell (Longview, 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
- 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 ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- HCA Healthcare (Houston, TX)
- …patients. The PODS/ Telehealth lead scheduler has good communication skills with patients, physician offices, as well as with the staff of the Pre-Admit **What you ... tasks. + Applies knowledge of rehab scheduling procedures to ensure maximum utilization of available staff and equipment. + Schedules and reschedules appointments… more
- Humana (Austin, TX)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Elevance Health (Grand Prairie, TX)
- …on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more