- HCA Healthcare (El Paso, TX)
- …and retrospective review of patient medical records for purposes of utilization review , compliance with requirements of external review agencies ... Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other… more
- CenterWell (Austin, TX)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... 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 (Houston, TX)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... experience is preferred. + Medical Management experience is preferred, + Utilization Review experience is preferred. + Knowledge of the medical management… 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
- Insight Global (Amarillo, TX)
- …accordance with member benefits and coverage criteria within defined turn-around times. Review of prior authorization requests in accordance with member benefits and ... coverage criteria within defined turn-around times. Review prior authorizations and determine opportunities for interventions. Coordinate appeals. Provide clinical… more
- Humana (Austin, TX)
- …Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management review organization ... us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments… more
- Oracle (Austin, TX)
- …are achieved, maintenances are performed with minimal risk, manage capacity utilization , address local maintenance requirements, and support technical projects. The ... responsibilities include change management, incident & event support, space utilization , efficiency upgrades, and general engineering support. Directors are expected… more
- HCA Healthcare (Dallas, TX)
- …participates in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement improvements ... design, collection, and reporting of adverse drug reactions, drug utilization reviews, medication errors and pharmacy quality initiatives +...Acts as manager in charge as assigned. + Provides review and guidance on physician order sets and other… more
- Toyota (Plano, TX)
- …Utilizing reporting, trackers, and systems, the Dealer Lending Portfolio Analyst will review metrics such as line utilization , audit results, financial ... performance, assessing financial performance, confirming Covenant compliance, and monitoring line utilization trends. + Act as a point of contact both internally… more
- ManpowerGroup (Plano, TX)
- …required; AA degree is a plus. + Minimum of 2+ years experience in a utilization review environment or similar work experience. + Knowledge of private insurance, ... Workers Compensation, and Medicare guidelines related to utilization review . + Proficient with Microsoft Office (Word & Excel); experience with medical billing… more