- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Texas Health Resources (Arlington, TX)
- …professional nursing in the state of Texas required upon hire ACM - Accredited Case Manager or CCM, CPHM or Milliman certification preferred upon hire Skills ... Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for… more
- Molina Healthcare (Fort Worth, TX)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- HCA Healthcare (Fort Worth, TX)
- …to you, we encourage you to apply for our Registered Nurse Case Manager PRN opening. Our team will promptly review your application. Highly qualified ... their positions. Join our Team as a Registered Nurse Case Manager PRN and access programs to...supporting a balance of optimal care and appropriate resource utilization . What You Will Do In This Role: +… more
- HCA Healthcare (Arlington, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse Case Manager opening. We review all applications. Qualified candidates will be ... you have the career opportunities as a Registered Nurse Case Manager you want in your current...supporting a balance of optimal care and appropriate resource utilization . What You Will Do In This Role: +… more
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Molina Healthcare (Fort Worth, TX)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… more
- AdventHealth (Mansfield, TX)
- …Experience Required + Registered Nurse (RN) License Required **Preferred qualifications:** + Certified Case Manager (CCM) Preferred + Accredited Case ... to 5:30 pm; schedule to be coordinated with Hiring Manager ) **Location:** 2300 LONESTAR RD, Mansfield, 76063 **The community...your career withAdventHealth, named in 2018 by Beckers Hospital Review as one of the 150 Top Places to… more
- AdventHealth (Mansfield, TX)
- …7:00am-5:30pm)** Flexibility with schedule specific schedule to be discussed with the manager . **Location:** 2300 Lone Star Road; Mansfield, TX 76063 **The community ... career with AdventHealth, named in 2018 by Beckers Hospital Review as one of the 150 Top Places to...community. **The role you'll contribute:** The Social Work Care Manager intervenes with patients who have complex psychosocial needs,… more
- Veterans Affairs, Veterans Health Administration (Duncanville, TX)
- …and from the community. Possesses the knowledge related to VHA guidelines, utilization review criteria, current evidence-based standards of care, compliance ... Summary The Registered Nurse - Nurse Manager - Community Home Care position is with...(may be extended up to two years on a case -by- case -basis.) NOTE: Grandfathering Provision - All persons… more
- Elevance Health (Grand Prairie, TX)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management. + Daily...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Molina Healthcare (Fort Worth, TX)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of… more
- Molina Healthcare (Fort Worth, TX)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical… more
- CenterWell (Arlington, TX)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... care being provided meets appropriate standards and to ensure cost-effective utilization practices. + Represent CenterWell/Conviva brands in local communities and… more
- Elevance Health (Grand Prairie, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... for clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- CenterWell (Fort Worth, TX)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... coaching initiatives are precise *Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving clinical excellence… more
- CenterWell (Arlington, TX)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... precise + Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving...of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and… more
- Elevance Health (Grand Prairie, TX)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... and/or medical policies. May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or skill of a… more
- Elevance Health (Grand Prairie, TX)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an ... the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review , drug monographs, and formulary recommendations. + Develop strategies to… more
- Elevance Health (Grand Prairie, TX)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review ** **Virtual:** This role enables associates ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more