- Molina Healthcare (San Antonio, TX)
- …rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + ... and other statistical methodologies to predict future trends in cost, utilization , and performance. + Assist with research, development and completion of… more
- HCA Healthcare (San Antonio, TX)
- …and actively participating in daily multidisciplinary and bedside rounds, completing drug utilization review to promote rational drug therapy, leading and ... to promote rational drug therapy and make improvements identified by drug utilization evaluations. + You will provide accurate and timely medication information to… more
- Elevance Health (Grand Prairie, TX)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- CenterWell (Fort Worth, TX)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization *Monitor and manage daily patient care and initiatives to improve… more
- Elevance Health (Houston, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant to other areas of… more
- Elevance Health (Grand Prairie, TX)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an ... the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review , drug monographs, and formulary recommendations. + Develop strategies to… more
- Molina Healthcare (TX)
- …analysts on software applications, business domain and design standards. *Conducts peer review of other analysts (internal and contract staff) to ensure standards ... Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among… more
- Highmark Health (Austin, TX)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- EMCOR Group (Dallas, TX)
- …and business objectives + Assist in implementing and auditing full utilization of existing tools to follow critical environment guardrails and checkpoints ... solutions provisions to expand business consistency between markets. + Review and assist in preparation of the scope of...program for field and management leaders + Ensure full utilization of existing tools and programs to follow policies… more
- HCA Healthcare (Live Oak, TX)
- …and actively participating in daily multidisciplinary and bedside rounds, completing drug utilization review to promote rational drug therapy, leading and ... to promote rational drug therapy and make improvements identified by drug utilization evaluations. + You will provide accurate and timely medication information to… more