- 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
- 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
- US Army Corps of Engineers (Fort Worth, TX)
- Summary About the Position: This Program Manager position is with the US Army Corps of Engineers, Southwestern Division, Fort Worth District, with a duty station ... of programs and projects. AND/OR 3. Developing cost estimates for utilization in negotiation and/or modification of Architectural-Engineering contracts. AND/OR 4.… more
- US Army Corps of Engineers (Fort Worth, TX)
- Summary About the Position: This Program Manager position is with the US Army Corps of Engineers, Southwestern Division, Fort Worth District, with a duty station ... of programs and projects. AND/OR 3. Developing cost estimates for utilization in negotiation and/or modification of Architectural-Engineering contracts. AND/OR 4.… 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
- AdventHealth (Mansfield, TX)
- …performance with oversight to assure capital and fiscal accountability. + Partners with Utilization Management for the Utilization Review Committee as well ... career with AdventHealth, named in 2018 by Beckers Hospital Review as one of the 150 Top Places to...closely with physicians and the campus leadership team on utilization / case management issues. Actively participates in outstanding… 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)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... + ACMP experience is preferred. + Medical Management experience is preferred, + Utilization Review experience is preferred. + Knowledge of the medical management… more
- Molina Healthcare (Fort Worth, TX)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… 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
- 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
- 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 ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more