- 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)
- …auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), ... Assists in preparation for regulatory audits by performing file review and preparation. + Participates in regulatory audits as...or related field. **Required Experience** + Minimum two years UM , CM, MAT, HM, DM, and/or managed care experience.… more
- Elevance Health (Houston, TX)
- …clinical reviews with attending physicians or other providers to discuss review determinations, and patients office visits with providers and external physicians. ... with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
- Molina Healthcare (Houston, TX)
- …Model * Adhere to UM policies and procedures * Mentor New Care Review Clinicians during orientation period *Sign off on core competencies for new Care Review ... Clinicians during peer mentoring phase *Model New programs, techniques and trainings with peers. **Job Qualifications** **Required Education** Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Rehabilitation Therapy (Occupational/Speech… more
- Houston Methodist (Nassau Bay, 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)
- …facility-based and outpatient professional treatment health benefits through telephonic or written review .** **Primary duties may include but are not limited to:** + ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- The City of Houston (Houston, TX)
- …tasks: + Manage and oversee that data is entered and stored accurately. + Consistent review of modules and reports to ensure that data is correct and supports the ... performance. + Establish policies, procedures, guidelines, and project schedules. + Review proposed contracts, correspondence, and amendments. + Review budget… more