- Evolent (Austin, TX)
- …focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates ... utilization management with collaborative engagement and innovation. **Core Responsibilities**...with collaborative engagement and innovation. **Core Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician… more
- Terracon (College Station, TX)
- …operations of a department including staff training, development, and performance review , utilization of equipment and facilities, safety oversight, quality ... or licensure in field of expertise. + Terracon Authorized Project Reviewer status preferred. **Exemption:** Exempt **Requisition ID:** 34027BR **Posting Title:**… more
- Molina Healthcare (San Antonio, TX)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
- Texas Tech University (Lubbock, TX)
- **43235BR** **Extended Job Title:** Analyst - Accessibility Review **Position Description:** Analyzes and coordinates office services such as personnel, budget ... preparation and control, fiscal affairs, equipment utilization , records control, and special management studies. **Requisition ID:** 43235BR **Travel Required:**… more
- Molina Healthcare (San Antonio, TX)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Texas A&M University - Faculty (College Station, TX)
- Tenure-Track/Tenure Review Upon Hire: Open Rank (Assistant Professor, Associate Professor, Full Professor) Pharmaceutical Sciences Location College Station Open Date ... Pharmacy in the Department of Pharmaceutical Sciences. This is an 11-month, tenure-track/tenure review upon hire position in College Station , and the start date is… more
- Houston Methodist (Houston, TX)
- …strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible ... enterprise-wide initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes, and… 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 ... of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital… more
- ChenMed (Houston, TX)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more