- San Antonio Behavioral Health (San Antonio, TX)
- The Director of Utilization Review (UR) in a behavioral health setting oversees the UR process, ensuring appropriate and cost-effective care while adhering ... collaborating with clinical staff to ensure optimal patient outcomes. Overseas utilization management and criteria-based reviews of care, clinical appeals regarding… more
- UTMB Health (Friendswood, TX)
- …trends of inappropriate resource utilization to Director and/or Assistant Director of Utilization Review /Case Management. + Maintains a documentation ... optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge,… more
- Baylor Scott & White Health (Dallas, TX)
- …Note: Benefits may vary based on position type and/or level **Job Summary** Utilization Review Specialist conducts reviews and shares knowledge with healthcare ... staff. Works closely with Medical Director and Health Services leadership. Manages utilization and formulates policies. The role is integral in navigating… more
- Evolent (Austin, TX)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director … more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Genesis Healthcare (Dallas, TX)
- …Area Director ). 9. Assumes responsibility for daily staffing and utilization with input from treating therapists, consideration of clinical requirements, and ... our Clinicians in Action professional development program. Responsibilities The Director of Rehab PTA is responsible for the efficient... in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area… more
- Humana (Austin, TX)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Molina Healthcare (Fort Worth, TX)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Humana (Austin, TX)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Centene Corporation (Austin, TX)
- …containment, and associated activities including quality improvement . + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Humana (Austin, TX)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs...size of team or line of business. The Medical Director conducts Utilization Management of the care… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social… more
- MD Anderson Cancer Center (Houston, TX)
- …students, trainees, professionals, employees and the public. The Executive Director of Institutional Shared Resources provides administrative, scientific, financial, ... to ensure the effective operation of the research enterprise. The Executive Director serves as the dedicated administrative leader for all institutionally supported… more
- Humana (Austin, TX)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- IBM (Austin, TX)
- …position. The key performance indicator (KPI) for the Cloud Economics - Program Director Business Analyst role is the achievement of vended spend savings, which is ... vended spend Additional KPIs related to Scorecarding/OKRs, Effective Technology Asset Utilization and Project Optima will be identified between the selected… more
- Texas State University (San Marcos, TX)
- …or nonprofit setting. + Demonstrated experience with fund tracking, gift utilization , and compliance monitoring. + Proven ability to manage multiple projects ... to advancement professionals and university stakeholders. Job Description The Director Stewardship provides leadership in ensuring that all donor contributions… more