- Molina Healthcare (Houston, TX)
- …(RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- Elevance Health (Houston, TX)
- …The **Medical Policy Analyst Sr.** is primarily responsible for the development, review , and maintenance of new and existing Elevance Health medical policies and ... clinical UM guidelines. Primary duties may include, but are not...support analysis of potential new medical policies and clinical UM guidelines + Investigates and develops analysis of potential… more
- Houston Methodist (Baytown, TX)
- …other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review , Precertification and ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Elevance Health (Houston, TX)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the identification ... responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact :** +...and data entry of referral requests into the UM system in accordance with the plan certificate. +… more