- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact...utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying ... or UR questions or issues arise. To support care management initiatives, the UM Reviewer should also identify enrollees in need of case/disease management… more
- Molina Healthcare (Houston, TX)
- …Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred… more
- Houston Methodist (Houston, 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
- Molina Healthcare (Houston, TX)
- …Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... hospitals as requested, may be required. This can vary based on the individual State Plan. + Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings. **JOB QUALIFICATIONS** **Required… more