- Texas Health Resources (Arlington, TX)
- Director Utilization Management - Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Cognizant (Austin, TX)
- …considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care ... submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical ...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- UTMB Health (Galveston, TX)
- …of the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and ... and reports trends of inappropriate resource utilization to Director /Assistant Director of Utilization Management . + Maintains a documentation system… more
- UTMB Health (Galveston, TX)
- Director of Pharmacy - Clinical Services **Galveston, Texas, United States** **New** Executive UTMB Health Requisition # 2505391 **Summary:** The Director of ... the delivery of high-quality, evidence-based, and cost-effective medication therapy management , aligning with organizational goals for clinical excellence,… more
- HCA Healthcare (Dallas, TX)
- …eligible. Do you want to join an organization that invests in you as a Clinical Director of Nursing? At Medical City Ambulatory Surgery Center, you come first. ... make a difference. We are looking for a dedicated Clinical Director of Nursing like you to... management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing… more
- HCA Healthcare (Houston, TX)
- …is incentive eligible. **Introduction** Do you have the career opportunities as a ** Clinical Director of Nursing** that you want with your current employer? ... of colleagues. Do you want to work as a(an) Clinical Director of Nursing - Surgery Center... management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing… more
- HCA Healthcare (Houston, TX)
- …incentive eligible. **Introduction** Are you ready to manage in a new era as a Director of Clinical Informatics where building a healthier tomorrow is more than ... hospital services happen at an HCA Healthcare facility. Be an impact as a(an) Director of Clinical Informatics where your passion for leading and creativity are… more
- Prime Therapeutics (Austin, TX)
- … Account Director - Remote **Job Description** The Clinical Account Director is responsible for the management of all client specific clinical ... programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy...+ PBM Experience + 1 year of direct client management experience + 1 year of clinical … more
- Molina Healthcare (TX)
- …of technology that drives core utilization management , care management , long-term services and supports (LTSS), clinical operations and business ... least 3 years management /leadership experience in a clinical leadership, clinical systems and/or informatics, utilization management , or care … more
- Prime Therapeutics (Austin, TX)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job ... Description** The Senior Director Clinical Strategy and Oncology Specialty Solutions is responsible for owning the execution of Prime's oncology specialty… more
- Highmark Health (Austin, TX)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... most current clinical standards. The incumbent reviews escalated cases electronically and...and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member… more
- Evolent (Austin, TX)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... You Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more
- Elevance Health (Grand Prairie, TX)
- …clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for ... to clients/ members. The medical director provides clinical expertise in all aspects of utilization ...for case management /complex clinical management . + Peer-to-peer outreach for both utilization … more
- Houston Methodist (Houston, TX)
- …and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the ... At Houston Methodist, the Director Case Management & Social Services...appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director … more
- Genesis Healthcare (Dallas, TX)
- …oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification is overseen by a licensed ... therapists, consideration of clinical requirements, and recommendations from the Clinical Director . 10. Administers financial controls of revenue and… more
- Evolent (Austin, TX)
- …on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Austin, TX)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Centene Corporation (Austin, TX)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- HCA Healthcare (Fort Worth, TX)
- …related hospital departments and external agencies to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all ... a part of our team. **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and coordinating… more
- Molina Healthcare (Austin, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more