- Scottish Rite for Children (Dallas, TX)
- …committed to giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention +… more
- Methodist Health System (Dallas, TX)
- …assessment of anticipated impact of external regulations and cost-containment efforts related to Utilization Review, Case Management . * Attains all agreed to ... implementing and supervising the day-to-day operation of the Care Management and Utilization Management Programs...of Federal, State and regulatory requirements in quality assessment, case management , resource management , hospital… more
- Elevance Health (Grand Prairie, TX)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For ... **Clinical Ops Associate Medical Director ** **Orthopedic Surgery** **Location:** This is a virtual...necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. +… more
- Molina Healthcare (Dallas, TX)
- …+ Delivers a unified or fully Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work cohesively to ... manage the needs of members holistically + Supports case management transformation and Integrated case...State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in… more
- Molina Healthcare (Dallas, TX)
- …across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes new standards ... to drive clinical excellence and quality results across the enterprise. + Identifies case management best practices and capabilities across all plans and Lines… more
- Molina Healthcare (Dallas, TX)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... gaps and barriers in implementation and compliance to AVP, VP and senior management . + Consultative role, develops business case methodologies for programs,… more
- Molina Healthcare (Dallas, TX)
- …efficiently and effectively. These pharmacists may also be involved in providing utilization management /prior authorization services. Key duties include any or ... to track general trends in drug utilization and identify potential targeted utilization management activities. + Works with Health Care Services (eg, with… more