- Centene Corporation (Austin, TX)
- …state of Texas** **RN, LCSW, LMHC, PLC, LMFT, LMHP** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Humana (Austin, TX)
- …Management Strategy Lead will bring deep expertise in utilization management (ie, across in-patient and out-patient clinical services, end-to-end UM ... and/or operations experience + Past experience working in a utilization management role (eg, clinical ...prior authorization and claims review , UM vendor management , analytics / reporting) + Knowledge of utilization… more
- Humana (Austin, TX)
- …you must have an active compact (Multistate) license, at least three (3) years of clinical and Utilization Management experience. The Utilization ... help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge… more
- Elevance Health (Austin, TX)
- …send you a check, or ask you for payment as part of consideration for employment. ** Utilization Management Rep II** + Job Family: CUS > Care Support + Type: Full ... + Ohio + Missouri + Kentucky + Florida **Description** ** Utilization Management Rep II** **Location: This is...with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and… more
- Ascension Health (Austin, TX)
- …Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure ... integration of utilization management functions with network strategy and...Develop systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully… more
- Humana (Austin, TX)
- …Caring, Curious and Committed? If so, apply today! The Utilization Management Behavioral Health Professional 2 + Uses clinical knowledge, communication ... put health first** Humana Healthy Horizons is seeking a Utilization Management Behavioral Health Professional 2 who...or Interqual Guidelines + Possess subject matter expertise in Utilization Review of inpatient and outpatient behavioral… more
- Centene Corporation (Austin, TX)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Sedgwick (Austin, TX)
- …RESPONSIBILITIES** + Accesses and assigns cases for medical case management , utilization review and clinical consultation. + Provides accurate ... callers based on customer requests; triages telephone calls between utilization review , clinical consultation and...staff through the completion of components of the case management and utilization review process.… more
- Prime Therapeutics (Austin, TX)
- …Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that ... **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases...as needed to discuss cases and problems. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Evolent Health (Austin, TX)
- …a Cardiology, Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- Prime Therapeutics (Austin, TX)
- …live in CA **Job Description Summary** Performs prospective and/or retrospective drug utilization review and appeals per State and Federal regulations. ... programs to provide optimal pharmacy care to patients, participates in drug utilization review programs, reviews assessment and documentation of patient care,… more
- Prime Therapeutics (Austin, TX)
- …and written communication skills. + Knowledge of legislative/oversight bodies (eg, URAC- Utilization Review Accreditation Commission, CMS-Centers for Medicare & ... onsite client presentations + Leads evaluation and identification opportunities for improved management of Medical benefit drugs through clinical research and… more
- CVS Health (Austin, TX)
- …to: + Provide progressive consultative clinical insights based on analysis of clinical plan utilization and impact of member behavior on medical plan costs ... data analysis. Working proactively with the account team, Care management teams, Plan Sponsor Insights, and other key enterprise...a member of the Plan Sponsor Insights team the clinical program consultant fulfills the company mission of helping… more
- Cardinal Health (Austin, TX)
- … clinical supply chain, safety compliance, product standardization and utilization . This position reports to Quality Director. **_Responsibilties_** + Present ... **_What Clinical Operations contributes to Cardinal Health?_** Clinical...influencing skills, ability to work cross-functionally. + Effective project management , organization, and prioritization skills + Demonstrate advanced knowledge… more
- Fresenius Medical Center (Austin, TX)
- **POSITION FEATURES:** Float Position Austin Area **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care ... is delivered while maintaining clinical operations. As the facility leader, you will be...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Sharecare, Inc. (Austin, TX)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... members of the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager. All Sharecare clinicians… more
- Highmark Health (Austin, TX)
- …Organization's Formularies, utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for ... Formularies, utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but not limited… more
- Humana (Austin, TX)
- …population. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... time to the Indiana Pathways program to assist the Utilization Management , Care Management , and...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical … more
- Wolters Kluwer (Austin, TX)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + Ongoing Utilization Management + Oversee customer utilization and product ... lead role in managing and driving our customer's product utilization across the Clinical Effectiveness (CE) product...be clients in the Midwest. **RESPONSIBILITIES** + Customer Relationship Management + Partner with Sales to build and maintain… more
- Marriott (Austin, TX)
- …of claims most likely to benefit from case management to meet jurisdictional needs. Utilization Review + Provide initial clinical review in order to ... losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if...case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases… more