- Healthfirst (TX)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **This position is 100% Remote **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
- Highmark Health (Austin, TX)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible for functional and operational aspects of the Case Mgmt./Social Work ... corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position… more
- Catholic Health Initiatives (Houston, TX)
- …where practicing required. * National certification of any of the following: CCM (Certified Case Manager ), ACM (Accredited Case Manager ) required or ... **Responsibilities** The Utilization Management ( UM ) Manager is responsible for managing...related clinical field * Minimum 5 years of clinical case management (Utilization Management, Denial Management, Care Coordination) *… more
- Highmark Health (Austin, TX)
- …resource utilization, identification of opportunities for referral to a Health Coach/ case management, and identification and resolution of quality issues. Monitors ... with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable state, federal… more
- Sanofi Group (Dallas, TX)
- **Job Title:** Field Reimbursement Manager , Rare Blood Disorders, Patient Support Services, Central **Location:** Chicago, IL / Dallas, TX / Denver, CO **About the ... Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management ( UM ) criteria create process delays for patients like required Benefits… more
- Sharecare (Austin, TX)
- …hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision ... members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance + Primary duties include but are not limited to: +… more