- Houston Methodist (The Woodlands, TX)
- …patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... benefits for patients and reimbursement for the hospital. + Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource … more
- Fresenius Medical Center (Olmito, TX)
- …+ Ensure effective communication with patients, dialysis clinics, hospitals and physician (s), to address any concerns/ issues Facility Operations + Participate in ... state regulations, and accrediting agency standards where applicable. + Participate in review business and finances of the site, including financial reports, market… more
- Humana (Austin, TX)
- …health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present educational… more
- CVS Health (Austin, TX)
- …- Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus **Preferred ... Qualifications:** -Health plan/payor Utilization Management / Review experience -Electronic medical systems/record experience -Managed Care experience -Medicaid… more
- Houston Methodist (The Woodlands, TX)
- …medical staff and system-wide administrative leadership from various areas and physician staff, as needed. The manager position responsibilities include managing the ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Houston Methodist (Houston, TX)
- …evaluation deems treatment requires additional medical evaluation or procedures. + Provides review and evaluation services for physician 's patients before clinic ... Demonstrate professional and technical competence in the selection, evaluation, utilization of treatment plans for increasingly complex patient populations.… more
- Houston Methodist (Houston, TX)
- …caring for adults in an acute care hospital setting is required; coding and utilization review experience preferred + For Medical School graduate - One year ... accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care… more
- Houston Methodist (Houston, TX)
- …many of the following: organize work schedules, create work assignments, review timecards for accuracy, conduct quality assurance audits of staff performance, ... customer requests. Responds promptly and appropriately to requests to code or review coded accounts for accuracy. Serves as liaison between team members, management… more
- Catholic Health Initiatives (Houston, TX)
- …Initiate the referral and evaluation process for potential transplant candidates. Review medical information, schedule testing including physician and ... results and compile data for presentation of patient's case at Medical Review Board. + Primary responsibility for the day-to-day course of in-hospital patients.… more
- HCA Healthcare (Fort Worth, TX)
- …to promote rational drug therapy and make improvements identified by drug utilization evaluations + Provide accurate and timely medication information to healthcare ... and adverse drug reactions + Participate in the data collection of drug utilization evaluations, adverse drug reactions, and pharmacy quality initiatives + Lead the… more