- Molina Healthcare (Dallas, TX)
- …using clinical and industry best practices: post-acute care ("SNFist" skilled nursing facility programs), model of care, palliative care, diabetes prevention, home ... health, prior authorizations/referrals. * Provides national best practice strategic direction and oversight for segment population management (including care management, utilization management, auditing and training). * Creates necessary cross-functional… more
- Molina Healthcare (Dallas, TX)
- …* Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. * Resolves escalated ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...* Prepares and presents cases in conjunction with the chief medical officer for administrative law judge… more
- Molina Healthcare (Dallas, TX)
- …experience. + Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state ... applicable policies/protocols. **REQUIRED QUALIFICATIONS:** + At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical… more
- HCA Healthcare (Dallas, TX)
- …regular communication with facility Chief Nursing Officers (CNO's) and Chief Medical Officer (CMO's) and engages them as key contacts regarding process ... EBCD, etc. to support staff training and continued education in collaboration with Nursing Education as needed. (crosses over to nursing education). + Actively… more
- Molina Healthcare (Dallas, TX)
- …and financial results, and keeps executive leadership apprised. * Collaborates with the chief medical officer and medical director team to develop and implement ... * At least 7 years health care management/leadership experience. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse… more
- Molina Healthcare (Dallas, TX)
- …Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer . * Evaluates authorization requests in timely support ... of nurse reviewers, reviews cases requiring concurrent review and manages...appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency,… more
- Molina Healthcare (Dallas, TX)
- …committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer . + Evaluates authorization requests in timely support of ... nurse reviewers; reviews cases requiring concurrent review, and manages...appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency,… more
- Molina Healthcare (Dallas, TX)
- …Communicates with the Molina Plan Senior Leadership Team, including the Plan President, Chief Medical Officer , national Risk Adjustment teams and strategic teams ... LICENSE, CERTIFICATION, ASSOCIATION:** * Certified Professional in Health Quality (CPHQ) * Nursing License (RN may be preferred for specific roles) * Certified Risk… more