- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …stay), concurrent review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services, payors, and community ... rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse (RN)… more
- Novo Nordisk Inc. (Houston, TX)
- … Director . Relationships Position reports to Field Director /Sr Field Director . Serves as organization spokesperson on advanced medical and technical ... About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk...monthly reports on scientific support activities in region to Director including budget expenditures as directed Records all activities… more
- Texas Children's Hospital (Bellaire, TX)
- …requests failing medical necessity criteria, and has collaborative discussion with the medical director or designee for review and disposition Documents ... Job Description We are searching for a Utilization Management Clinical RNsomeone who works well in...due to unique member situation and delivers that to medical director /designee Works closely with UM Analyst… more
- Syneos Health Careers (Dallas, TX)
- …the senior strategic lead for multi-project accounts at Cadent. The Account Director provides management support and oversight for account project leads, drives ... Client Management Demonstrate ability to communicate with clients about account and medical affairs strategic needs that lead to organic growth Facilitate regular… more
- Healogics (Livingston, TX)
- …care providers across the wound care continuum, Wound Care Center (WCC)(R) Providers, and Medical Director regarding clinic and patient needs. May function as a ... that would benefit through our out-patient clinic partnerships The Clinical Program Director is responsible for the management and the strategic growth of the… more
- Trinity Healthcare LLC (Sealy, TX)
- …Serve on various committees of the facility: Infection Control, Quality Assurance, Utilization review , etc. Monitor for Safety issues during daily rounds. ... descriptions. Perform administrative requirements such as completion of necessary medical forms, reports, evaluations, studies, charting, etc. as required. Attend… more
- Harris Health System (Houston, TX)
- …Review of adverse determination letters for accuracy and appropriateness of Medical Director documentation to ensure compliance to all regulatory requirements ... County taxpayers. Skills / Requirements JOB SUMMARY The Secondary Review and Notification RN is responsible for subsequent ...if needed. This position will work closely with the Utilization Management (UM) team, Service Coordination (SC) team and… more
- JobAdX (Olmito, TX)
- …meeting minutes.Provide support to the Medical Executive Committee as requested by the Medical Director and in accordance with the Medical Staff Bylaws. ... any governmental or regulatory body having jurisdiction in the premises. Assists the Medical Staff to ensure that medical practices and procedures meets… more
- UnitedHealth Group (Brownsville, TX)
- …accurate and up to date information to the H&C Transitions Sr. Manager or Medical Director Assure appropriate referrals are made to the Health Plan, High-Risk ... (as indicated) according to CMS criteria When H&C Transitions is delegated for utilization management, review referral requests that cannot be approved for… more
- Memorial Hermann Health System (Houston, TX)
- …decreasing cost; provides clinical services to patients and professional staff; interacts with medical staff on drug utilization and cost containment. May be ... Job Summary Memorial Hermann's Cancer Center located in the world-renowned Texas Medical Center seeks an Oncology Clinical Pharmacy Specialist to join our team.… more
- Knapp Medical Center (Weslaco, TX)
- …accreditation standards. Activities include but are not limited to integrity reliability review , medical chart reviews, data abstraction for CMS Core Measures ... committed to our core values of quality, compassion, and community! Knapp Medical Center, a member of the Prime Healthcare Foundation, offers incredible… more
- UHS (Denton, TX)
- …patients, assisting with establishing effective and timely payment plans, coordinating with utilization review and discharge planning efforts to limit risk of ... expiration; communicate on a daily basis with the Business Office Director . Benefit Highlights Tuition savings with Chamberlain University Career development… more
- Elevance Health (Houston, TX)
- **Clinical Operations Associate Medical Director ** **Home Health Utilization Review ** **Carelon Medical Benefit Management** **Virtual:** This role ... attention, any case review decisions that require Medical Director review or policy...Skills, Capabilities, and Experiences:** + 1+ years experience in utilization review / utilization management preferred +… more
- Evolent (Austin, TX)
- …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...Provides medical direction to the support services review process. Responsible for the quality of utilization… more
- Evolent (Austin, TX)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Austin, TX)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... Medicaid. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Humana (Austin, TX)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... performing utilization management for inpatient authorizations training medical director team to assist and facilitate...**Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure… more
- Evolent (Austin, TX)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Austin, TX)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Fort Worth, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
