- Texas Health Resources (Arlington, TX)
- Director Utilization Management - Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Molina Healthcare (Fort Worth, TX)
- …must be active and unrestricted in state of practice. * Deep understanding of clinical operations: utilization management , care management , etc. * ... JOB DESCRIPTION Job Summary Leads and directs a team supporting clinical performance improvement activities. Responsible for continuous improvement and successful… more
- Elevance Health (Grand Prairie, TX)
- …clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for ... to clients/ members. The medical director provides clinical expertise in all aspects of utilization ...for case management /complex clinical management . + Peer-to-peer outreach for both utilization … more
- HCA Healthcare (Fort Worth, TX)
- …related hospital departments and external agencies to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all ... a part of our team. **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and coordinating… more
- Molina Healthcare (Fort Worth, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more
- Molina Healthcare (Fort Worth, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality...analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory,… more
- Elevance Health (Grand Prairie, TX)
- …Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... **Behavioral Health Medical** ** Director -Psychiatrist** **Appeals** **Location:** This role enables associates to...an entire clinical program and/or independently performs clinical reviews. + Typically has program management … more
- Molina Healthcare (Fort Worth, TX)
- …EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization /Quality Program Management ... Molina's Behavioral Health function provides leadership and guidance for utilization management and case management ...psychiatric diagnoses and treatment * Provides second level BH clinical reviews, BH peer reviews and appeals * Supports… more
- Molina Healthcare (Fort Worth, TX)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- CenterWell (Fort Worth, TX)
- …to adapt responsibilities as needed and demands a unique blend of clinical management , financial/business acumen, and strategic partnership to optimize patient ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader...clinical leader of our primary care team, combining clinical practice with leadership and operational management … more
- CenterWell (Arlington, TX)
- …to adapt responsibilities as needed and demands a unique blend of clinical management , financial/business acumen, and strategic partnership to optimize patient ... and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader...clinical leader of our primary care team, combining clinical practice with leadership and operational management … more
- Molina Healthcare (Fort Worth, TX)
- …health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and ... - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Elevance Health (Grand Prairie, TX)
- **Plan Performance Medical Director ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... granted as required by law. The **Plan Performance Medical Director ** serves as a lead clinician and oversees the...This role involves managing the overall medical policies and clinical guidelines to ensure appropriate and cost-effective care. The… more
- Elevance Health (Grand Prairie, TX)
- …experience, which would provide an equivalent background. **Preferred Qualifications:** + Utilization management experience preferred. For candidates working in ... **Medical Director Associate - CarelonRx** **Location:** This role enables...locations may be considered. CarelonRx delivers market-leading pharmacy benefit management and medication dispensing services to drive affordability and… more
- Elevance Health (Grand Prairie, TX)
- ** Clinical Operations Associate Medical Director ** **Carelon Medical Benefits Management ** **Radiology Benefit Management / Utilization Review** ... granted as required by law._ The ** Clinical Operations Associate Medical Director ** is responsible for supporting the medical management staff ensuring… more
- Molina Healthcare (Fort Worth, TX)
- …experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... medical policy/procedure development, and provider contracting experience + Current clinical knowledge + Experience demonstrating strong management and… more
- Molina Healthcare (Fort Worth, TX)
- …with knowledge of foundational Health Insurance Operations; particularly Utilization Management , Care Management , and Clinical Operations + Ability ... Supports the maintenance of IT Project accounting in project management tools. Works with Program Director on...operations + Knowledge of Health Insurance Utilization Management , Care Management , and Clinical … more
- AdventHealth (Burleson, TX)
- …Responsible and accountable for planning, organizing, coordinating, and evaluating the management and clinical practice activities for the nursing unit(s) ... Education* (Certifications and Degrees without out-of-pocket tuition expense) - Nursing Clinical Ladder Program* **Our promise to you:** Joining Texas Health Huguley… more
- AdventHealth (Burleson, TX)
- …Nurse Manager is a specialized health care professional who reports to the department Director and collaborates with the Director and other leaders to provide ... of selected patient populations across the continuum of illness; promoting effective utilization of and monitors health care resources; and assumes a leadership role… more
- Elevance Health (Grand Prairie, TX)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians,...equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more